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Menstrual cycle and appetite control: Implications for weight regulation

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Hormonal fluctuations associated with the menstrual cycle influence appetite control and eating behaviour. Energy intake varies during the reproductive cycle in humans and animals, with a periovulatory nadir and a luteal phase peak. Patterns of macronutrient selection show less consistency but a number of studies report carbohydrate cravings in the premenstrual phase, particularly in women with premenstrual syndrome. The cyclical nature of food cravings are frequently, but not invariably, associated with depression. Fluctuations in appetite, cravings and energy intake during the menstrual cycle may occur in parallel with cyclical rhythms in serotonin, which can be accompanied by affective symptoms. The premenstrual phase can be considered as a time when women are especially vulnerable to overconsumption, food craving and depression; this is often associated with low serotonin activity.
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Human Reproduction vol.12 no.6 pp.1142–1151, 1997
Menstrual cycle and appetite control: implications for
weight regulation
L.Dye
1
and J.E.Blundell
prior to the onset of menstruation and which are relieved at
or shortly after commencement of menstrual flow. In its most
BioPsychology Group, Department of Psychology, University of
severe form this is also known as premenstrual dysphoric
Leeds, Leeds LS2 9JT, UK
disorder (PMDD) (Gold, 1994)*. Although a large range of
1
To whom correspondence should be addressed
symptoms have been associated with PMS, the more common
symptoms which can be said to characterize the syndrome
Hormonal fluctuations associated with the menstrual cycle
influence appetite control and eating behaviour. Energy include depression, irritability, mood swings, water retention-
intake varies during the reproductive cycle in humans and
based symptoms such as breast tenderness and bloating,
animals, with a periovulatory nadir and a luteal phase
changes in appetite and food cravings. These symptoms can
peak. Patterns of macronutrient selection show less consist-
be measured using subjective rating scales. The distinction
ency but a number of studies report carbohydrate cravings
between PMS and PMDD relates to the severity of the
in the premenstrual phase, particularly in women with
symptoms. PMDD is less prevalent than PMS, affecting ~5%
premenstrual syndrome. The cyclical nature of food crav-
of women. To be clinically significant, it is generally accepted
ings are frequently, but not invariably, associated with
that the symptoms of PMDD that a sufferer experiences must
depression. Fluctuations in appetite, cravings and energy
endure consistently, at a severe level, for at least two cycles
intakeduringthemenstrualcyclemayoccurinparallelwith
(American Psychiatric Association, 1994). For the purposes
cyclical rhythms in serotonin, which can be accompanied
of this review, the term PMS is used to encompass mild and
by affective symptoms. The premenstrual phase can be
severe forms of premenstrual symptoms. Over the years a
considered as a time when women are especially vulnerable
number of assertions have been made about the relationship
to overconsumption, food craving and depression; this is
between the existence of this syndrome and changes in food
often associated with low serotonin activity.
consumption which could influence weight regulation.
Key words: appetite/food craving/menstrual cycle/serotonin
Eating behaviour and appetite control
Particular physiological and psychological characteristics of
Introduction
the menstrual cycle and PMS could influence the expression
In this last decade of the twentieth century, obesity is becoming
of appetite through a variety of mechanisms and processes
an ever increasing public health problem. In turn this has
which influence the control of food intake. The overall regula-
stimulated the current epidemic of dieting (Blundell and Bauer,
tion of eating is complex and can best be envisaged as a
1994). At the same time people are confronted by a vast array
psychobiological system which serves to integrate biological
of food products, and food consumption is heavily promoted.
and environmental influences (e.g. Blundell, 1991). One
Dieting is particularlycommon in young women. It is estimated
important feature of the environment is, of course, the nutri-
that 40–50% of women are on a diet at any one time (Polivy
tional composition of the food supply. Human food intake
and Herman, 1987). Factors which influence the ease of
can be assessed by means of quantitative aspects of food
overconsumption and the difficulty of underconsumption are
consumption such as the energetic value of food and its
likely to be important in the maintenance of a stable body
macronutrient composition (proportion of fat, protein and
weight and in the prevention of the development of obesity.
carbohydrate). Appetite is also represented by qualitative
The regular hormonal fluctuations associated with the men-
aspects such as food choice, food preferences and appreciation
strual cycle may influence appetite control and eating behavi-
of the sensory aspects of food (taste, palatability, mouth-feel
our. In addition, particular conditions associated with the
etc.). In addition, subjective phenomena such as the perception
menstrual cycle, most notably premenstrual syndrome (PMS),
of hunger, fullness and hedonic sensations which accompany
may predispose women to changes in appetite control. It is
therefore important to identify any changes in eating associated eating are also important (Hill et al., 1995). Along with these
with the menstrual cycle in general, and with PMS in particular,
characteristics of consumption are particular food cravings
in order to be able to deal effectively with any implications
and urges to eat food in general or specific food products.
for health and well-being.
Consequently, the phenomenon that scientists and others call
*PMDD replaces late luteal phase dysphoric disorder (LLPDD) in
What is the premenstrual syndrome?
Diagnostic and Statistical Manual of Mental Disorders, 4th edn
The premenstrual syndrome is a collection of behavioural,
(American Psychiatric Association, 1994). LLPDD appeared in a
research appendix to the third edition of this manual.
somatic and physical symptoms which occur in the 7–10 days
1142
© European Society for Human Reproduction and Embryology
Menstrual cycle and appetite control
Figure 1. The fundamental elements influencing the control of food intake. The diagram illustrates how hormonal fluctuations underlying
the menstrual cycle exert direct and indirect effects on the homeostatic system controlling food intake and the pattern of eating.
food intake can be analysed in terms of structured patterns of rhythms, energy balance, and adjustments in various com-
ponents (qualitative and quantitative) of food intake. It followseating (meals, snacks etc.) and nutritional components (selec-
tion of fat, carbohydrate etc.). Subjective sensations (the that hormonal changes could directly alter the biological drive
to modulate eating or could exert an indirect influence byexperience of a drive to eat) accompany these patterns and
may be thought of as causing these adjustments. It follows physiological adjustment so as to make individuals more
susceptible or vulnerable to facilitating or stimulating environ-that any changes induced by the hormonal fluctuations of the
menstrual cycle or by PMS may be detected in various aspects mental forces.
of eating, including changes in hunger, cravings for certain
foods, alteration in meal size or snacking, adjustments in
consumption of fat or carbohydrate and an overall change in
Menstrual cycle changes in food intake
energy intake.
Animal studies
The schematic diagram in Figure 1 indicates how food
intake forms part of a homeostatic system whilst also being Cyclical changes in hunger motivation or food intake have
been observed in many animal species during the oestrusadapted to environmental demands. Two particularly important
features of our current environment are the prevalence of cycle; studies indicate a consistently lower intake around the
time of ovulation. In rodents, feeding is depressed coincidentdieting as a lifestyle for many women, and the abundance of
high-fat, highly palatable foods in the food supply. The with oestrus (Brobeck et al., 1947; Jennings, 1969; Herberg
et al., 1972; Wade, 1972; Leshner and Collier, 1973; Tarttelinhomeostatic system does not operate in symmetrical fashion.
The system appears tobe strongly defended against undereating and Gorski, 1973). However, human and other primate men-
strual cycles are distinctly different to the oestrus cycle of thebut only weakly protected against overconsumption (see Blund-
ell, 1996). Therefore, whereas dieting to lose weight is rodents. Primates have a prolonged luteal phase following
ovulation, which is characterised by elevated levels of circulat-extremely difficult, overconsumption is relatively easy and can
occur passively. In turn, this passive overconsumption is likely ing progesterone (Rosenblatt et al., 1980).
Studies in a number of primate species (see Table I) indicateto lead to weight gain and possibly obesity (Lawton et al.,
1993). This means that any overconsumption (either via that highest food intake occurs consistently in the luteal phase
with the nadir of food intake around the time of ovulationgenerally increased energy intake or involving cravings or
urges for particular foods) which occurs premenstrually is (Krohn and Zuckerman, 1938; Gilbert and Gillman, 1956;
Czaja, 1975; Rosenblatt et al., 1980). An ovulatory decreaselikely to lead to incremental weight gain which, in turn, will
engender accompanying psychological problems. in food intake has also been observed in other mammals
such as pigs (Friend, 1969) goats (Forbes, 1971) and sheepFigure 1 illustrates how hormonal changes underlying the
menstrual cycle can modulate the principles of homeostatic (Tarttelin, 1968).
Initially, elevated food intake in the luteal phase wasregulation. This means that hormonal rhythms will influence
the capability of people to undereat (to maintain dieting), and attributed to increased concentrations of progesterone (Gilbert
and Gillman, 1956). Later, the ovulatory decrease in intakethe ease of overconsumption. It seems appropriate to use this
model to account for the relationship between hormonal was attributed to the appetite-suppressant effects of oestrogen
1143
L.Dye and J.E.Blundell
The time of ovulation represents the nadir of food intake
Table I. Cyclical patterns of food intake in mammals
during the menstrual cycle (Lyons et al., 1989; Gong et al.,
1989; Fong and Kretch, 1993; Johnson et al., 1994). Moreover,
Intake phase
it has been suggested that these changes in eating parallel
Species Highest Lowest Reference
changes in basal metabolic rate across the menstrual cycle
(Solomon et al., 1982; Webb, 1986). Specifically energy
Baboon Luteal Follicular/ Gilbert and Gillman
ovulatory (1956)
expenditure has been shown to increase in the postovulatory
Rhesus monkeys Luteal Ovulatory Rosenblatt et al. (1980)
phase (Webb, 1986). This could be due to separate hormonal
Rhesus monkeys Luteal Ovulatory Czaja (1978)
action on energy intake and expenditure respectively, or to the
Pigtail monkeys Luteal Ovulatory Krohn and Zuckerman
(1938)
driving action of energy intake on some aspect of energy
Pig Pre-ovulatory Friend (1969)
expenditure (such as diet-induced thermogenesis).
Goat Ovulatory Forbes (1971)
One potential explanation for the fluctuations in food intake
Sheep Ovulatory Tarttelin (1968)
Guinea-pig Ovulatory Czaja and Goy (1975)
is alterations to insulin sensitivity during the menstrual cycle.
Rat Oestrus Herberg et al. (1972)
Marsden et al. (1996) assessed carbohydrate metabolism and
insulin sensitivity at receptor and post-receptor level in women
(Czaja, 1975, 1978), the luteal phase increase being thus due
in the follicular or luteal phase of an ovulatory ovarian cycle,
to the inhibitory action of progesterone on oestrogenic activity.
in the physiological target organ adipose tissue. They found a
Given the relatively similar reproductive cycles of primates
reduction in insulin receptor binding in the luteal phase but
and humans, it is to be expected that similar fluctuations in
no change in overall insulin action on adipocyte glucose uptake
food intake should occur during the menstrual cycle, under
and lipolysis. The effect of menstrual cycle phase, i.e. of
natural conditions.
hormone concentrations on insulin binding, is congruent with
impaired insulin sensitivity in conditions where concentrations
Human studies
of oestrogen and progesterone are raised either artificially, as in
In humans, when food intake has been examined in relation
oral contraceptive use, or naturally, as in pregnancy. However,
to the menstrual cycle a distinct pattern of fluctuation has
although receptor binding is altered in the luteal phase,
been observed. Generally, energy intake is higher in the
compensatory change in the post-binding sites allows overall
postovulatory or premenstrual phase of the cycle than in the
insulin action in adipocytes to remain normal.
preovulatory or follicular phase (see Table II for review of
research). Examination of these phases has usually focused on
two 10 day periods either side of ovulation.
Macronutrient intake
In the majority of studies luteal energy intake is significantly
In contrast to cyclic effects on total energy intake, reports
higher than energy intake in the follicular phase. Of 30 studies
about the patterns of macronutrient intake during the menstrual
that compare cycle phases in 37 groups of women, 25 studies
cycle are less consistent (see Table III) and sometimes have
report significantly higher luteal energy intake than follicular
achieved celebrity status.
intake. The remaining 12 comparisons show no significant
There has been some suggestion of significantly increased
effect, though the trend for similar groups in each study is
carbohydrate consumption premenstrually (Dalvit-McPhillips,
invariably in the same direction. The two exceptions are
1983; Hrboticky et al., 1989; Lyons et al., 1989; Brzezinski
Wurtman et al. (1989) and Krakow (1992) who show follicular
et al., 1990), reductions in protein and carbohydrate intake at
energy intake to be non-significantly greater than luteal intake
ovulation (Lyons et al., 1989), and premenstrual increases in
in subjects with no premenstrual symptoms and women not
fat intake (Anantharaman-Barr et al., 1988; Tarasuk and
taking oral contraceptives respectively. Both of these studies,
Beaton, 1991; Johnson et al., 1994) or in fat and protein
however, have some inherent methodological weaknesses. For
intake (Gallant et al., 1987). The increase in carbohydrate
example, in both studies participants were aware of the
consumption has been referred to as carbohydrate craving and
menstrual cycle focus, a factor known to influence reporting
has been regarded as an index of a particular type of eating
(Ruble, 1977), and in Wurtman et al.s study screening for
disorder (Wurtman, 1993).
PMS was based on retrospective reports which are likely to
There are however, inconsistencies both between and within
amplify any cyclical pattern (Warner et al., 1991).
studies. Results may differ depending on whether actual intake
In contrast, such statistically significant cycle-related trends
(in grams) of a macronutrient or the relative proportion that a
are not observed in women using oral contraceptives
macronutrient contributes to total percentage energy intake is
(Anantharaman-Barr et al., 1988; Krakow, 1992), or women
considered. While absolute intake of a macronutrient may
with anovulatory cycles (Barr et al., 1995). In both of these
increase significantly from the follicular to luteal phase (e.g.
conditions, cyclic fluctuations in hormones are absent or
Barr et al., 1995), the percentage of energy intake as, e.g., fat
minimized. In addition, eating trends across the menstrual
or carbohydrate may fail to differ. The well-publicized view
cycle are not seen in women with highly restrained eating
has been that it is carbohydrate intake that increases in the
patterns (Schweiger et al., 1992). This could be due to the
luteal phase (Wurtman et al., 1989). However, there are an
effects of low energy intake on hormonal cycles, or because
equal number of studies which document significant increases
of a tonic inhibition of eating which obscures any underlying
physiological influence. in fat intake at this stage of the cycle. Such results may
1144
Menstrual cycle and appetite control
Table II. Cyclical patterns of energy intake in women
Study Sample size Days measured Energy intake (MJ)
Luteal (L) Menstrual Follicular (F) Ovulatory L versus F
Abraham et al. (1981) 23 35 (whole cycle) nr nr nr nr L . F*
Anantharaman-Barr et al. (1988) 22–8oc 7days pre/7 days post nr nr ns
14 noc nr nr L . F*
Barr et al. (1995) 45 29 ovulatory 333 days (pre/ovul./post) 3.27 8.01 nr L . F*
13 anovulatory 7.91 8.21 nr F . Lns
Brzezinski et al. (1990) 17 PMS meals 1 day pre/1 day post 7.28 6.04 L . F*
snacks 3.86 1.80 L . F*
Dalvit (1981) 8 10 days pre/10 days post 8.12 6.02 L . F*
Dalvit-McPhillips (1983) 8 10 days pre/10 days post 7.22 5.22 L . F*
Fong and Kretch (1993) 9 1–28 (whole cycle) 10.46 10.31 9.87 9.39 ns
Gallant et al. (1987) 18 –9 control 233 days (pre/post) 8.09 6.27 L . F*
–9 PMS 6.56 5.71 L . Fns
Giannini et al. (1985) 20 whole cycle nr nr nr nr no cyclical
trend
Gong et al. (1989) 7 1–28 (whole cycle) 8.54 7.89 7.67 7.39 L . F*
Hill and Blundell (1989) 12 PMS whole cycle nr L . F*
Hrboticky et al. (1985) 8 1 day pre/1 day post 7.72 7.52 L . F
Hrboticky et al. (1989) 10 1 day pre/1 day post nr nr L . F*
Johnson et al. (1994) 26 1–28 (whole cycle) 7.84 7.6 7.15 7.15 L . F*
Krakow (1992) 98 47 noc whole cycle 8.23 8.64 8.803 F . Lns
47 oc whole cycle 8.86 8.64 8.58 L . Fns
Lariviere et al. (1994) 8 231 days (pre/post) 8.29 7.39 L . F*
Lissner et al. (1988) 23 10 days pre/10 days post 9.77 9.41 L . F*
Lyons et al. (1989) 25 1–28 (whole cycle) 9.13 9.05 8.45 7.87 L . F*
McCoy et al. (1988) 12 7 days pre/7 days post 8.95 8.27 L . F*
Manocha et al. (1986) 11 10 days pre/10 days post 6.74 5.44 L . F*
Martini et al. (1994) 18 3 days pre/3 days post 7.98 7.32 L . F*
Netter et al. (1993) 40 disturbed eaters 9 days pre/9 days post nr nr L . F*
non-disturbed nr nr L . F*
Oram (1987) 6 10 days pre/10 days post 11.56 8.74 L . F*
Piers et al. (1995) 13 5 days pre/5 days post 7.12 7.12 ns
Pliner and Fleming (1983) 34 1 days pre/1 days post 8.42 7.49 L . F*
Rogers and Jas (1994) 42 (snacks) 25 L/17 follicular 3.35 1.46 L . F*
Schweiger et al. (1992) 21 13 unrestrained 12 days pre/12 days post 9.42 9.08 L . F*
9 restrained 7.21 6.99 L . Fns
Sophos et al. (1987) 9 7 days pre/7 days post 7.79 7.44 L . Fns
Tarasuk and Beaton (1991) 14 10 days pre/10 days post 8.00 7.62 L . F*
Wurtman et al. (1989) 19 control 1 day pre/1 day post 8.46 8.72 F . Lns
9 PMS 1 day pre/1 day post 10.02 7.92 L . F*
*Significant difference between luteal and follicular phases (P . 0.05). nr 5 measured but actual intake not reported; oc 5 oral contraceptive; noc 5 no oral
contraceptive; PMS 5 premenstrual syndrome; ns 5 non-significant.
represent general increases in appetite rather than specific or behaviour. This problem is compounded when multiple
phases are compared and degrees of freedom reduced. Further-increases in intake of a particular macronutrient.
more, few studies have taken account of menstrual cycle-
related symptoms, which are most commonly reported in the
Methodological issues
premenstrual phase. These symptoms may influence behaviour
All studies on the menstrual cycle are confronted by formidable
in an indirect way (in contrast to direct hormonal influence).
methodological problems. Studies of food intake and the
Consequently, in our view, research on the pattern of eating
menstrual cycle often contain some serious methodological
and motivation accompanying the menstrual cycle should be
flaws or inconsistencies. These include techniques for recording
critically examined and cautiously interpreted.
food intake, inadequate determination of menstrual cycle
phases, the failure to consider more than two (rather long)
Premenstrual syndrome and food intake
cycle phases and the frequent ‘averaging’ across menstrual
cycles. These methodological problems will reduce the PMS is characterized by the dramatic occurrence of symptoms
in the premenstrual phase, which are relieved following thesensitivity of experiments and may jeopardize the validity of
the conclusions made about the nature of fluctuations in food onset of menstruation. Increases in appetite and/or food crav-
ings are considered characteristic of PMS. A frequent dilemmaintake during the menstrual cycle.
One frequent problem concerns those experiments using which arises in studies of PMS is whether PMS is an extreme
of the normal experience of the menstrual cycle or is asmall numbers of subjects; these studies may not have had
sufficient statistical power to detect small effects in motivation qualitatively different phenomenon.
1145
L.Dye and J.E.Blundell
Table III. Macronutrient intake (% of energy intake) in the follicular (F) and luteal (L) phases
Carbohydrate Fat Protein
Study n FL FL FL
Abraham et al. (1981) 23 nr* nr* nr* nr* nr* nr*
Barr et al. (1995) 29 ovulatory 57.5 56.1 28.9 31.3 12.7 12.4
13 anovulatory 56.3 54.1 30.5 32.9 12.5 13.1
Tarasuk and Beaton (1991) 14 43.8 43.07 36.01 37.56* 14.56 14.12
Dalvit-McPhillips (1983) 8 39.9 55.8* 44.4 32.6* 15.7 11.6
Fong and Kretch (1993) 9 44.2 44.5 41.9 41.7 12.9 13.0
Gallant et al. (1987) 9 43.1 40.9 36.6 37.7* 13.9 15.7*
9 PMS 34.6 40.0 48.8 43.6 15.0 16.0
Johnson et al. (1994) 26 47.5 47.9 35.4 37.4* 15.4 14.7
Lyons et al. (1989) 18 47.0 45.9 35.8 36.8 13.5 13.4
Oram (1987) 6 46.5 42.2 37.1 38.1 14.5 16.4
Schweiger et al. (1992) 9 unrestrained 42.0 43.0 41.0 40.0 13.0 14.0
9 restrained 45.0 39.0 39.0 40.0 13.0 14.0
Sophos (1987) 14 47.3 46.1 36.4 33.7 15.2 15.1
Martini et al. (1994) 18 51.3 50.1 33.1 34.2 15.6 15.6
Hrboticky et al. (1989) 8 54.02 54.09 28.03 28.31 13.35 13.4
Brzezinski et al. (1990) 17 PMS
meals 28.6 32.5* 48.65 48.1* 21.1 17.01
snacks 27.9 32.8* 52.3 50.5* 17.7 15.2
*Significant difference between luteal and follicular phases (P . 0.05). nr 5 measured but actual intake not
reported; PMS 5 premenstrual syndrome.
In relation to food intake, the former view would imply that more calories, protein, fat and vitamin B
6
premenstrually.
Increases in intake for the PMS subjects were smaller than forPMS sufferers experience similar temporal fluctuations in
appetite and intake to ‘normal’ women but at a greater intensity. controls. These data are in contrast to the findings of Dalvit-
McPhillips (1983) which show an increase in carbohydrateThere have, however, been few objective studies of intake in
PMS sufferers. Two studies report luteal intake to be signific- intake premenstrually. The macronutrient data reported by
Dalvit-McPhillips (1983) does not correspond to total energyantly higher than follicular intake (Hill and Blundell, 1989;
Brzezinski et al., 1990), one a non-significant trend in the intakes reported previously from the same women (Dalvit,
1981) and Dalvit’s subjects were not reported to be PMSsame direction (Gallant et al., 1987) and one a non-significant
reversed effect (Wurtman et al., 1989). Both studies which sufferers. Rogers et al. (1992) have suggested that foods which
are preferentially consumed premenstrually tend to be highlyfail to detect effects (Gallant et al., 1987; Wurtman et al.,
1989) are based on far fewer subjects than the studies which palatable and with high hedonic properties. These foods tend
to be high in both carbohydrate and fat. Indeed, the 12%confirm the similar pattern of increased luteal energy intake
in PMS sufferers as non-symptomatic women. Giannini et al. energy increase reported by Hill and Blundell (1989) was
mainly due to a rise in the number of high fat/high carbohydrate(1985) reported a positive relationship between caloric intake
and severity of PMS symptoms. Women who reported more snacks consumed. It is therefore difficult to draw firm conclu-
sions about specific changes in macronutrient consumption.severe symptoms recorded higher caloric intake. However,
while caloric intake was measured by daily intake diaries,
PMS symptoms were assessed by retrospective questionnaire
PMS, mood and food cravings
at the end of the study, a method which tends to exaggerate
symptom reporting. Studies of food craving during the menstrual cycle have
produced a range of findings about both the pattern and natureMore recently, Both-Orthman et al. (1988) found an increase
in subjective ratings of appetite in the premenstrual phase as of food cravings. The predominant trend, however, seems to
be an increase in both the frequency and severity of foodcompared with the postmenstrual phase in both PMS and
control subjects. Levels of reporting in the premenstrual phase craving in the premenstruum. This is clearly depicted in Figure
2, based on data from 5546 women who reported symptomswere significantly higher in the PMS subjects than in the
controls. Concurrent ratings of mood and depression were in a retrospective questionnaire (Dye et al., 1995). Even
allowing for some elevation in reporting given the retrospectivesignificantly correlated with ratings of appetite in the premen-
strual phase for the PMS subjects only, suggesting a relationship nature of the study, a clear increase in food craving in the
premenstrual phase (compared with postmenstrual) is evident.between mood and appetite which distinguishes this group
from the control (non-PMS) group. This coincidence of appetite This pattern is true for severe and moderate food cravings.
Interestingly, for mild food cravings the opposite pattern isincrease and mood change has led to suggestions that these
may be causally linked. observed. This suggests that food cravings are more frequent
and more severe premenstrually, but they can also occur in aConcerning the intake of specific macronutrients Gallant
et al. (1987) found that both control and PMS subjects much weaker form at other points in the menstrual cycle in
the same women.increased carbohydrate intake postmenstrually but consumed
1146
Menstrual cycle and appetite control
Figure 2. Percentage of subjects reporting food cravings (varying
degrees of severity) at three stages of the menstrual cycle. These
Figure 3. Relationship between the incidence of food cravings and
data show a greater frequency and intensity of cravings in the
three phases of the menstrual cycle in three groups of women. The
premenstrual phase. This figure is based on data from a sample of
graph indicates non-depressed women (square symbols), women
5546 women (adapted from Dye et al., 1995).
with chronic depression (diamonds) and women with depression
only during the premenstrual phase (circles). The vertical axis
This tendency for increased food craving in the pre-menstrual
indicates the degree of reported food craving on a scale from 1
(mild) to 4 (severe). (Adapted from Dye et al., 1995.)
phase has been observed in varied samples of women (e.g.
with and without PMS and/or premenstrual depression), sug-
gesting that the experience of PMS sufferers is more severe
but not necessarily qualitatively different from that of normal
women. There does not seem to be a difference in the foods
which are craved (as opposed to frequency or severity) by
PMS or non-PMS subjects. However, it is worth considering
closely whether the craved foods belong to any particular
nutrient category (e.g. carbohydrates).
This is important because of the known effects of food on
mood and the well-documented incidence of mood change
(particularly depression) in the premenstrual phase, especially
in PMS sufferers. Consequently, a relationship between food
craving (possibly for carbohydrate-rich foods) and depression
could occur. The logic of this relationship is that women crave
those particular foods whose consumption would ameliorate
the depression. Some studies have indicated that these two
symptoms may co-exist premenstrually (Cohen et al., 1987;
Figure 4. Relationship between the incidence of food cravings and
Bancroft et al., 1988). A more recent study has clarified the
the severity of depression in three phases of the menstrual cycle.
relationship between food craving and depression.
The vertical axis indicates the severity of reported food craving on
Figure 3 is based on 919 women, selected on the basis of
a scale from 1 (mild) to 4 (severe). Bars indicate concurrent rating
their clear patterns of depression rating during three menstrual
of depression from none to severe during each of three menstrual
cycle phase (horizontal axis). The figure is based on data from a
cycle phases. From the figure, it is evident that depression is
sample of 5546 women (adapted from Dye et al., 1995).
positively related to food craving. In women with ‘chronic’
depression (i.e. depression reported as severe or very severe
in each cycle phase examined) ratings of food craving are food cravings of this PMS group are identical to those of the
‘chronic depressed’ group when their depression ratings areelevated to a ‘moderate’ level at each phase. This contrasts
with the low ratings of food craving observed in women who also the same, but the level of craving falls to that of the non-
depressed group when depression also falls.report no depression at any phase of the cycle (‘non-depressed’
group). This latter group, however, do show a cyclical pattern The relationship between food cravings and depression in
Figure 3 clearly suggests that these menstrual cycle-relatedin their reports of food craving, indicating that a rhythm of
craving can occur in the absence of depression, but at a lower symptoms are not independent. These data, however, are based
on approximately one-fifth of the original data, i.e. thoselevel. The pattern of craving shown by those women who
reported severe or very severe depression only in the premen- women with relatively easily classified temporal patterns of
depression (n 5 919). Figure 4 shows the relationship betweenstrual phase (a feature which characterizes the PMS) confirms
the relationship between food craving and depression. The depression rating and food craving rating during each phase
1147
L.Dye and J.E.Blundell
of the menstrual cycle for a large sample of unselected women 1984) and in response to oestradiol administration (Kato,
1960). In humans, concentration of serotonin (V
max
) is lowest(n 5 5 546). A positive linear relationship between depression
and food craving is evident in each cycle phase. The more premenstrually (Taylor et al., 1984; Tam et al., 1985). There
is evidence that serotonin levels in whole-blood, and plasmasevere the rating of depression, the greater the degree of food
craving. The occurrence of more severe food cravings in and platelet uptake and content are lower premenstrually in
women with PMS (Rapkin et al., 1987; Ashby et al., 1988,the premenstrual phase (in contrast to the menstrual and
postmenstrual phases) is also clear. The interrelationship 1992). Similar fluctuations have been observed in melatonin,
which is synthesized from serotonin (Parry, 1994).between food craving and depression is maintained at all
phases of the menstrual cycle and the size of the sample Neuroendocrine challenge tests have been used to measure
changes in serotonin function. Normally, infusion of thesuggests a robust relationship between these symptoms at all
phases of the menstrual cycle. serotonin precursor
L
-tryptophan (or fenfluramine) produces
an increase in plasma prolactin. In women with PMS, prolactin
responses to a neuroendocrine challenge test are blunted
The role of serotonin in food intake and food craving
premenstrually (Halbreich, 1990; Bancroft et al., 1991). The
neuroendocrine response can be affected by dieting in womenIn recent years, research has identified the neurotransmitter
serotonin [also known as 5-hydroxytryptamine (5-HT)] as a (Goodwin et al., 1987), a factor not controlled for in these
studies.particularly important component of the biological system
influencing eating (Blundell, 1977). Serotonin is implicated in The serotonin agonist, buspirone, has a high affinity for 5-
HT
1A
receptors. Yatham et al. (1989) found that the prolactinthe effects of dietary composition on brain function (e.g.
Fernstrom and Wurtman, 1971) and in the control of meal response to a buspirone challenge test was greater during the
luteal phase and suggested that this is due to supersensitivitypatterns and the urge to eat (Blundell, 1992). Since serotonin
is also implicated in physical and psychological symptoms of 5-HT
1A
receptors at this time. These results were confirmed
by Dinan et al. (1990) who excluded the possibility of variableoccurring during the menstrual cycle (and especially in PMS),
a consideration of the role of serotonin may help in the absorption during the menstrual cycle. Buspirone has also been
reported to have beneficial effects on premenstrual symptomsunderstanding of appetite changes related to PMS.
Serotonin has been implicated as the mediating factor in the (David et al., 1987; Rickels et al., 1989), as have other
serotoninergic compounds such as fluoxetine (Rickels et al.,relationship between mood and appetite (Wurtman, 1993).
This hypothesis is based on the evidence that low levels of 1990; Stone et al., 1991; Menkes et al., 1992; Wood et al.,
1992).
D
-Fenfluramine has been shown to be effective inserotonin induce dysphoric mood. It is argued that craving for
particular food products (containing carbohydrates) occurs in suppressing luteal increases in appetite in PMS sufferers (Hill
and Blundell, 1989; Brzezinski et al., 1990). However, theseorder to raise the levels of serotonin in the brain and it has
been suggested that this may be an adaptive mechanism to studies conflict in their findings on mood symptoms.
Thus studies in women with PMS show a consistent trendcompensate for a relative lack of serotonin premenstrually.
Therefore eating CHOs serves as a form of self-medication to toward decreased levels of serotonin premenstrually (Severino,
1994). A recent study (Ulrich et al., 1994) has demonstratedraise mood. The mechanisms through which the carbohydrate
content of the diet influences the uptake of tryptophan into the that central, hypothalamic regulation of follicle stimulating
hormone (FSH) and prolactin release involves serotonin, spe-brain and in turn increases the synthesis of serotonin has been
well described elsewhere (Fernstrom and Wurtman, 1971). cifically 5-HT
3
receptor-mediated processes. There is also well-
documented evidence of serotonin’s role in the regulation ofIt has been demonstrated (Wurtman et al., 1989) that the
deliberate administration of carbohydrate can relieve premen- the oestrous cycle in rodents (Vitale and Chiocchio, 1993).
These data, coupled with evidence of rhythmicity in peripheralstrual depression in PMS sufferers, defined by retrospective
symptom ratings. The consumption of a carbohydrate-rich, serotonin, suggest that while ovarian steroids may modulate the
serotonergic system, serotonin also modulates gonadotrophinprotein-poor evening meal improved mood in PMS sufferers
in the late luteal phase but had no effect on mood in the secretion.
Serotonin is also implicated in the aetiology of depression,follicular phase or in non-symptomatic control subjects. This
is consistent with a carbohydrate-induced increase in serotonin and neuroendocrine findings in women are consistent with a
higher incidence of depression in women than in men (Meltzer,occurring during the premenstruum. However, as noted earlier
there is little evidence for a selective craving for carbohydrate 1990). However, we cannot infer that peripheral serotonin
levels predict central levels in humans, although such afoods premenstrually or for a preferential intake of carbohyd-
rate. Consequently, the idea that individuals attempt to medicate relationship has been demonstrated in non-human primates
(Raleigh and McGuire, 1980). On the basis of the findingthemselves by eating carbohydrate is not yet substantiated.
However, there are other reasons to consider a role for serotonin (McGuire et al., 1983) that the serotonin system of the vervet
monkey may be affected by environmental factors and socialin premenstrual food craving and increased energy intake.
Ovarian steroids may have a modulating role in the sero- interaction, Rapkin (1992) has developed an appealing theory
of physiological deregulation of the serotonin system. Thistonergic system, affecting metabolism, activity and receptors
(Rapkin, 1992; Severino, 1994). Animal studies suggest proposes that physiological down-regulation, i.e. reduction in
serotonin, may produce negative somatic and behaviouralchanges in serotonin levels during the oestrus cycle (Biegon
et al., 1980; McEwen and Parsons, 1982; Fischette et al., symptoms such as those which characterize PMS, whereas
1148
Menstrual cycle and appetite control
women without PMS may be able to minimize deregulation concerned about their weight and shape and are likely to be
dieting. Given the increased susceptibility to risk factors forvia for instance, environmental interaction.
The effects of lowered serotonin are most likely to be overconsumption likely to be present just before menstruation,
dieting will be even more difficult to sustain during this periodobserved in those behaviours most closely regulated by the
neurotransmitter. It can be suggested that the fluctuation in and there are likely to be more frequent occurrences of counter-
regulation (Polivy and Herman, 1985).appetite and energy intake observed in women during the
menstrual cycle reflect cyclical rhythms in serotonin, which To date, however, these hypotheses remain untested because
the prevalence of PMS in dieters, the ease of adherence to amay be accompanied by affective symptoms in women with
PMS but which are present to a lesser degree (or are better diet during the premenstrual phase and the effect of dieting
on premenstrual symptoms have not been studied. This is antolerated) in women without PMS. Serotonin has been shown
to influence both satiation (meal size) and satiety (post-meal area which merits further research.
Since this review concerns the relationship between appetiteinhibition) (Blundell, 1992). During the premenstrual phase,
serotonin activity is relatively low, and therefore there will be control and hormonal conditions linked with reproductive
function, it is worth drawing attention to a possible role forrelatively weaker control over appetite. Indeed it can be
deduced that altered activity at particular serotonin receptors the ob-protein (‘leptin’) (Halaas et al., 1995). It has been
proposed that leptin serves as a signal linking adipose tissue(5-HT
1B
and 5-HT
2C
) modulates the ability to resist risk factors
for overeating and a positive energy balance (Blundell, 1996). to central neural pathways. In animals and humans the plasma
concentrations of leptin correlate well with body mass indexConsequently, during the premenstrual phase individuals will
be more susceptible to many stimuli (internal and environ- (BMI) and percentage body fat. Consequently, this ob-protein
could be the much sought after lipostatic factor. In addition,mental) that facilitate eating and elicit food craving. Thus, the
premenstrual phase of the menstrual cycle can be considered it has been demonstrated that injections of leptin can restore
fertility in mutant mice (ob/ob) which have difficulty reprodu-a time when women are especially vulnerable to overconsump-
tion and craving, and also to depression (due to low sero- cing (Chehab et al., 1996). Injections of leptin also cause an
early onset of reproductive function in normal female micetonin activity).
(Chehab et al., 1997). These effects may occur because leptin
signals the amount of body fat and because reproductive
Dieting and the menstrual cycle
function is normally switched off when levels of body fat fall
too low. In humans it is known that leptin levels are very lowMost of this discussion has been concerned with the effects
of hormonal changes on food intake. It should be borne in in patients with anorexia nervosa (Grinspoon et al., 1996) and
that female athletes with amenorrhea fail to display a diurnalmind, however, that food intake also affects hormones, and
therefore food intake will affect the rhythm of the menstrual rhythm of leptin (Laughlin and Yen, 1997). Although the role
of leptin in appetite control in humans remains to be verified,cycle. One major dimension here is the concept of dieting,
which may involve ~40% or more of the female population. some interaction between leptin, serotonin and reproductive
hormones could shed further light on appetite fluctuationsDieting can be defined as self-induced attempts to restrict food
consumption and to control the pattern of eating. Therefore within the menstrual cycle. However, at the moment this idea
should be considered speculative.dieting is likely to influence measured food consumption, food
choice and other aspects of eating. Pirke (1987) and Pirke
et al. (1989) have shown that dieting causes menstrual irregular-
Conclusions
ities. The ovarian cycle was disrupted by either disturbed
follicular development, i.e. the lack of development of a It is clear that PMS is a clinical phenomenon with implications
for health and well-being. However, considerable methodologi-dominant follicle and low levels of oestrogen, or by luteal
phase defects, i.e. impaired progesterone secretion by the cal problems face researchers who investigate PMS and other
phenomena associated with the menstrual cycle. A wide varietycorpus luteum. The former effect results in absolute infertility,
the latter in significantly compromised fertility. In addition, of characteristics and events have been attributed to the rhythm
of the menstrual cycle and to the premenstrual phase inepisodic luteinizing hormone secretion during the follicular
phase was altered by dieting. Three major factors which particular. Definitive statements cannot yet be made about
certain issues. However, we feel that the following generalinfluence this relationship have been identified: (i) age: younger
women are more susceptible to diet-induced menstrual irregu- conclusions can be drawn from the published body of research;
(i) Orderly fluctuations in eating and other measures of foodlarities; (ii) amount of weight loss: the greater the weight loss
the higher the likelihood of menstrual irregularities; (iii) the consumption do occur during the menstrual cycle. Generally
there is an increase in energy intake and appetite during thenature of the diet: vegetarian diets affect the cycle more than
a non-vegetarian diet, even when both cause the same amount pre-menstrual phase (when compared to the ovulatory or
postmenstrual phases); (ii) This increase in energy intake andof weight loss.
It follows that any studies on the relationship between appetite during the premenstrual phase also occurs in women
who suffer from PMS. In these women the appetite changeshormonal state, food cravings and eating should take into
account the prevalence of dieting among women in the study may be experienced with greater intensity and given increased
psychological emphasis; (iii) During the premenstrual phasesample. This is particularly important in studies on PMS since
it is known that a large proportion of PMS sufferers are food cravings are increased in frequency and intensity. Food
1149
L.Dye and J.E.Blundell
Cohen, I.T., Sherwin, B.B. and Fleming, A.S. (1987) Food cravings, mood
craving appears to be more severe in women with PMS; (iv)
and the menstrual cycle. Horm. Behav., 21, 457–470.
Food craving is positively related to depression during the
Czaja, J.A. (1975) Food rejection by female rhesus monkeys during the
menstrual cycle. Food craving is more intense when depression
menstrual cycle and early pregnancy. Physiol. Behav., 14, 579–587.
Czaja, J.A. (1978) Ovarian influences on primate food intake: Assessment of
is severe, and depression is greater during the premenstrual
progesterone actions. Physiol. Behav., 21, 923–928.
phase. Food craving is linked to depression in women with
Czaja, J.A. and Goy, R.W. (1975) Ovarian hormones and food intake in
PMS; (v) These changes in appetite and cravings indicate the
female guinea pigs and rhesus monkeys. Horm. Behav. 6, 329–349.
probability of active or passive overconsumption of food
Dalvit, S.P. (1981) The effect of the menstrual cycle on patterns of food
intake. Am. J. Clin. Nutr., 34, 1811–1815.
during the premenstrual phase and in women with PMS. In
Dalvit-McPhillips, S.P. (1983) The effect of the human menstrual cycle on
turn, this suggests a potential for weight gain; (vi) Changes in
nutrient intake. Physiol. Behav., 31, 209–212.
serotonin metabolism are implicated in the vulnerability to
David, D., Freeman, A. and Harrington, T.M. (1987) Buspirone for anxious
risk factors, increased food consumption, food craving and
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Dinan, T.G., Barry, S., Yatham, L.N. et al. (1990). The reproducibility of the
could be treated by behavioural, nutritional or pharmaceutical
prolactin response to buspirone: relationship to the menstrual cycle. Int.
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Clin. Psychopharm., 5, 119–123.
activity of serotonin.
Dye, L., Warner, P. and Bancroft, J. (1995) Food craving during the menstrual
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... As early as the 1990s, scientists observed that women's eating behavior varied with the menstrual cycle (Barr et al., 1995;Dye & Blundell, 1997). Dietary intake was found to be higher during the luteal phase than during the follicular phase (Alonso-Alonso et al., 2011;Asarian & Geary, 2006;Brennan et al., 2009;Bryant et al., 2006;Cross et al., 2001;Dye & Blundell, 1997;Frank et al., 2010;Gorczyca et al., 2016;Reed et al., 2008;Van Vugt, 2010). ...
... As early as the 1990s, scientists observed that women's eating behavior varied with the menstrual cycle (Barr et al., 1995;Dye & Blundell, 1997). Dietary intake was found to be higher during the luteal phase than during the follicular phase (Alonso-Alonso et al., 2011;Asarian & Geary, 2006;Brennan et al., 2009;Bryant et al., 2006;Cross et al., 2001;Dye & Blundell, 1997;Frank et al., 2010;Gorczyca et al., 2016;Reed et al., 2008;Van Vugt, 2010). ...
... For example, women reported that the intake of food and cravings for foods high in fat and/or carbohydrates were higher in the luteal phase than in the follicular phase (Asarian & Geary, 2006;Bryant et al., 2006;Cross et al., 2001;Davidsen et al., 2007;Gorczyca et al., 2016;Reed et al., 2008). At the same time, other results did not show any differences in food intake in different menstrual cycle phases (Barr et al., 1995;Dye & Blundell, 1997;Gorczyca et al., 2016). Results on the consumption of sweets are conflicting too, with some findings showing higher cravings for sweets when estrogen concentrations are high (Krishnan et al., 2016) and others showing fewer cravings and a lower food intake during these phases (Gorczyca et al., 2016;Leeners, Geary, et al., 2017). ...
Article
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Background : As eating behavior changes in relation to the menstrual cycle and weight changes with menopausal transition, ovarian hormones appear to be involved in regulating eating behavior. However, observations are contradictory and are difficult to compare, due to methodological problems related to nutritional epidemiology. To better understand the relationship between ovarian steroid hormones and eating behavior, our study evaluates women's responses to visual food cues at different points in the menstrual cycle with their specific serum estrogen/progesterone levels and women's responses in the case of strong estrogen changes in the context of fertility treatments. Methods : We collected data from 129 women, 44 of whom received in vitro fertilization (IVF) at the Department of Reproductive Endocrinology, University Hospital Zurich. A total of 85 women with natural cycles were recruited at the University Hospital Zurich (n=37) and at the Hannover Medical School (n=48). Our observational study used 4 different measurement time points across the natural cycle and 2 measurement time points in women with supraphysiological estradiol levels during fertility treatments. Using a second cycle, we then tested our results for replication. At these predefined time points, women were shown pictures of 11 categories of food, with 4 items for each category and blood samples for measurement of hormone levels were taken. Food preferences registered at the time of the investigation were indicated on a visual analogue scale (0-100). Results : We did not find any statistically significant association between women's serum hormone levels and the rating of visually presented food, either during the menstrual cycle or during fertility treatments after controlling for multiple testing (all p>0.005). Ratings for fruits, vegetables, and carbohydrates showed a significant linear decline throughout the first menstrual cycle (p<0.01), which did not replicate in the second cycle (p>0.05). In contrast, the ratings for sweets showed a significant linear decline in both cycles (both p<0.01), with a mean rating of 54.2 and 48.8 in the menstrual phase of the first and second cycle, respectively, to a mean rating of 47.7 and 43.4 in the premenstrual phase of the first and second cycle, respectively. During fertility treatments, no food rating showed a significant change (all p>0.05). Mood such as negative and positive affects did not influence ratings for visual food cues neither throughout the menstrual cycles nor during fertility treatment. Conclusions : Serum levels of estradiol and progesterone do not correlate with food ratings in women, even when estradiol levels are above the physiological level of a natural menstrual cycle. Since, except for sweets, significant changes in food ratings in a first cycle did not replicate in a second menstrual cycle, significant findings from the literature based on animal or human studies focusing on a single-cycle have to be interpreted with caution.
... Although acute environmental stress suppresses appetite, mild chronic stress is suggested to increase appetite and change eating behavior (Swaffield & Guo, 2020). In addition, it has been shown that appetite control over women's menstrual cycle could change due to hormonal fluctuations (Dye & Blundell, 1997). Controlling appetite during different situations of life could be beneficial to prevent overeating and weight gain. ...
... In addition, appetite can be affected by mood and vice versa (Rogers, 1995). Therefore, being interrelated with many situations and durations of a regular lifestyle, appetite should be controlled to reduce the risk of chronic diseases (Dye & Blundell, 1997;Rogers, 1995;Swaffield & Guo, 2020). ...
Article
Appetite control has attracted many scientists' attention recently since it can lead to weight management and the prevention of further metabolic disorders. Many studies have been carried out to assess the effect of flaxseed on satiety perception but the results are controversial. This study aims to review these results comprehensively. PubMed/Medline, Web of Science, Scopus, and Cochrane databases were searched for related papers on June 2021. The searched keywords for appetite were: visual analog scale, appetite, desire to eat, satiation, satiety, hunger, fullness, and for Flaxseed they were: flax, flax*, linseed*, lignin*, Linseed Oil, flaxseed, ground flaxseed, flaxseed oil, and Linum usitatissimum. The 13 included studies were inconsistent in results and some of them found no significant effect of flaxseed on the considered outcomes. However, three studies revealed a significant reduction in hunger perception as well as appetite. Moreover, two studies found a decreasing effect on prospective consumption. Three studies observed a positive significant effect on fullness and satiety. Although there are a limited number of documents related to the effect of flaxseed on appetite perception, or its equivalent terms, the available studies suggest the potential role of flaxseed in decreasing appetite and hunger.
... This study also has some limitations. First, as the intervention period was 10 weeks, we could not ensure that measurements were taken in the same phase of the menstrual cycle, which is known to have an impact on appetite [43]. However, the distribution was likely to occur at random, so there is no strong indication that this constitutes an issue. ...
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Objective: The aim of this study was to compare changes in hedonic hunger and food reward in individuals with severe obesity achieving 10% to 15% weight loss with a very low-energy diet (VLED) alone or VLED and bariatric surgery. Methods: Patients scheduled for sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) initiated a VLED 2 weeks prior to surgery and continued the diet for 8 weeks postoperatively. BMI-matched controls underwent a VLED for 10 weeks. Hedonic hunger was assessed with the Power of Food Scale, and food reward with the Leeds Food Preference Questionnaire, pre and post intervention. Results: A total of 44 participants completed the study: 15 SG, 14 RYGB, and 15 controls (61%, 79% and 69% females, respectively; BMI: 40.5 ± 0.5 kg/m2 ; age: 43.9 ± 1.4 years). Average weight loss was 18.3 ± 0.6 kg (16%), comprising 13.5 ± 0.5 kg fat mass, with no significant differences between groups. Similar reductions in hedonic hunger were observed in all groups. Overall, food reward was similarly reduced in SG and RYGB groups, whereas controls showed little or no change. Conclusions: Independent of modality, weight loss seems to reduce hedonic hunger, but bariatric surgery leads to several additional favorable changes in food reward and preferences.
... mmol·L -1 , and 3±2.4 mmol·L -1 vs. 6.5±1.7 mmol·L -1 after interval 2 and 4, respectively. Neither were significantly different).A strength of the study includes controlling for stage of the menstrual cycle in a within-subject manner, as eating behaviour can differ across the menstrual cycle(Buffenstein et al., 1995;Dye and Blundell, 1997;Brennan et al., 2009). Additionally, EI over a 4-day period has been demonstrated to be increased in inactive women taking oral contraceptives compared with inactive women not taking oral contraceptives(Rocha et al., 2018). ...
Article
High-intensity intermittent exercise (HIIE) has been shown to transiently suppress appetite, but such exercise has traditionally required the use of specialist apparatus (e.g., cycle ergometer). This study aimed to determine appetite and eating behaviour responses to acute apparatus-free HIIE in inactive women with excess weight. A preliminary study (n=18 inactive women, 9 healthy weight, 18.0-24.9kg∙m⁻²; 9 with excess weight, 25.0-34.9kg∙m⁻²) revealed that intervals of 30 seconds of “all out” star jumping elicited physiological responses akin to intervals of 30 seconds of “all out” cycling. Twelve women (29.2±2.9kg∙m⁻², 38±7years, 28±39minutes MVPA∙week⁻¹) then completed three trials in a within-subject, randomised cross-over design: 4 × 30sec “all out” star jumping (4 × 30sec); 2 × 30sec “all out” star jumping (2 × 30sec); resting control (CONT). Upon completing each late-morning exercise trial, lunch was provided upon request from the participant. The time from the exercise bout to lunch request – termed eating latency – was recorded, and ad libitum food intake at lunch was measured. Subjective appetite was measured using a visual analogue scale before and after exercise, and at lunch request. Free-living energy intake (EI) and energy expenditure (EE) were recorded for the remainder of the trial day and the three days following. Change-from-baseline in subjective appetite was significantly lower immediately after 4 × 30sec (-9.6±18.4mm) and 2 × 30sec (-11.5±21.2mm) vs. CONT (+8.1±9.6mm), (both p < 0.05, d = 0.905 and 1.027, respectively). Eating latency (4 × 30sec: 32±33min, 2 × 30sec: 31±26min, CONT: 27±23min, p = 0.843; η²p = 0.017) and lunch EI (4 × 30sec: 662±178kcal, 2 × 30sec: 715±237kcal, CONT: 726±268kcal, p = 0.451; η²p = 0.077) did not differ significantly between conditions. No significant differences were observed in trial day EI and EE, or in EI and EE on the three days following exercise (all p > 0.05). Mean trial day relative EI (EI – EE) was 201±370kcal lower after 4 × 30sec than CONT, but this difference was not statistically significant (p = 0.303, d = 0.585). In conclusion, very low-volume star jumping elicited a transient suppression of appetite without altering eating behaviour. (313 words)
... During the LT phase, the granular cells start to accumulate a yellow pigment called lutein, which, together with other cells, forms the corpus luteum [7]. 2 Significant alterations in hormones occur during the various phases of the menstrual cycle. Of note, these changes are associated with changes in appetite control and, during the premenstrual phase, many women are prone to excessive energy intake [8] as well as variations in emotional processing and behavioural memory [9,10]. Other studies have focused on the relationship between the menstrual cycle and stress and haemodynamic and cardiovascular responses [11,12], and on how it can influence metabolism during exercise [13]. ...
Article
Full-text available
Objective: To evaluate changes in body composition and strength after menstrual cycle-based or traditional undulating resistance training (RT) programs in women. Equipment and methods: Ten resistance-trained and eumenorrheic women (26.6 ± 3.0 years; 164.7 ± 6.5 cm; 62.3 ± 6.8 kg) were randomly assigned to a menstrual cycle-based periodized upper/lower training (n = 5, MC) or an undulating training group (n = 5, UT) for 8 weeks. The number of repetitions and load were adjusted to each phase of the menstrual cycle. Fat, R. Romance et al. mass (FFM) and fat mass (FM) were evaluated by dual x-ray absorptiometry (DXA); maximal strength was assessed by the 1 repetition maximum (1-RM) test in the back squat (SQ) and bench press (BP); and muscle power was assessed by the countermovement jump (CMJ) test using a jump contact mat. Results: A significant increase in FFM was observed for UT (1.4 ± 0.9 kg, P = 0.043, ES = 0.58) with no difference in MC (1.7 ± 1.8 kg, P = 0.080, ES = 0.25). No changes in FM were observed for either condition (MC: 0.9 ± 1.2 kg, p = 0.225, ES = 0.21 and UT: 0.5 ± 1.0 kg, P = 0.345, ES = 0.13). Strength increases were observed for both MC an UT in the BP (8.9 ± 3.4 kg, p = 0.042, ES = 0.87 and 5.0 ± 1.8 kg, p = 0.039, ES = 0.67, respectively) and SQ (15.3 ± 9.2 kg, P = 0.043, ES = 0.93 and 16.4 ± 7.6 kg, P = 0.042, ES = 1.38, respectively). CMJ showed differences in MC (4.0 ± 2.5 cm, P = 0.043, ES = 1.12). We observed a between-group difference in BP (P = 0.041) favoring MC; no other interactions were found. Conclusions: Eight weeks of a menstrual cycle-based periodized training combined with a hyperenergetic diet versus a non-matched undulating RT program have a differential impact on body composition and muscular adaptations in trained women. © 2022 L'Auteur(s). Publié par Elsevier Masson SAS. Cet article est publié en Open Access sous licence CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).
... Therefore, in the current study, traditional diet pattern might not be associated with prevalence of PMS. Second, individuals with PMS are prone to have depressive mood and stronger cravings for refined carbohydrate and fat foods [35,36]. Third, a western dietary pattern is closely related to chronic low-grade inflammation, and several studies proved significant positive associations between serum levels of inflammatory markers (e.g., high-sensitivity C-reactive protein, interleukin-12, and interferon-γ) and menstrual symptom severity in women with PMS [37,38]. ...
Article
Full-text available
Premenstrual syndrome (PMS) adversely affects the physiological and psychological health and quality of life of women. Mediterranean diet (MD) could be helpful for managing and preventing PMS, but evidence on the association between dietary patterns and PMS in Asian women is limited. This study aimed to investigate the association of dietary patterns and adherence to MD with PMS in Korean women. This cross-sectional study recruited 262 women aged 20–49 years via an online survey. PMS was diagnosed using the American College of Obstetricians and Gynecologists diagnostic criteria. MD adherence was assessed using the Korean version of the Mediterranean Diet Adherence Screener. Mediterranean Diet Score (MDS) was classified into tertiles (T) (T1: 0–3, T2: 4–5, and T3: ≥6). Dietary pattern was assessed with the Food Frequency Questionnaire. Multiple logistic regression analyses were conducted to evaluate the association between dietary pattern scores and PMS prevalence. The proportion of PMS was significantly lower in MDS tertile (T) 3 than in T1 (55.4% in T3 vs. 74.4% in T1, p = 0.045). After adjusting for confounders, participants in the highest tertile of the bread/snack pattern had a higher risk of PMS (odds ratio [95% CI]: 2.59 [1.32–5.06]), while traditional dietary pattern and meat/alcohol pattern were not associated with PMS. In conclusion, we found that low adherence to MD and higher bread/snack dietary pattern were associated with increased risk of PMS, respectively.
... The mean change (0.77%) between the two phases in BM measured by BIA was higher than the CV% (0.10%) and the magnitude of the effect had moderate size according to Cohen's d. Since TBW did not change significantly, this increase in BM could be due to increased appetite and food consumption (Dye and Blundell 1997;Akturk et al. 2013), but we did not check these variables in the present study. Dokumacı and Hazır (Dokumacı and Hazır 2019) reported no change in BM, BF%, and FFM in well-trained athletes comparing exactly the same two points of the menstrual cycle as the current study. ...
Article
Background: Changes in estradiol and progesterone hormones and associated fluid retention during the menstrual cycle phases might affect body composition (BC) in women. Aim: The main objectives of this study were to determine the changes in whole and regional BC by dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance (BIA) during the mid-follicular (MFP) and mid-luteal (MLP) phases. Subjects and methods: Thirty recreationally active young women participated in this study. BC was measured by DXA and BIA during MFP and MLP. A mixed linear model for repeated measures analysis was used to determine the differences between the two phases. Results: Body mass was higher during MLP than MFP, while total body water, total and segmental fat mass and fat percentages measured by both BIA and DXA were similar during the two phases. DXA-derived fat-free mass and soft lean mass in the android region were higher during MLP than MFP. Large variability in individual responses was evident. Conclusion: On average, whole and segmental BC variables do not change significantly between MFP and MLP. However, given the large variability among the individual responses, it is suggested to perform repeated BC measurements during the same phase of the menstrual cycle.
Article
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Obesity in women of reproductive age has a number of adverse metabolic effects, including Type II Diabetes (T2D), dyslipidemia, and cardiovascular disease. It is associated with increased menstrual irregularity, ovulatory dysfunction, development of insulin resistance and infertility. In women, estradiol is not only critical for reproductive function, but they also control food intake and energy expenditure. Food intake is known to change during the menstrual cycle in humans. This change in food intake is largely mediated by estradiol, which acts directly upon anorexigenic and orexigenic neurons, largely in the hypothalamus. Estradiol also acts indirectly with peripheral mediators such as glucagon like peptide-1 (GLP-1). Like estradiol, GLP-1 acts on receptors at the hypothalamus. This review describes the physiological and pathophysiological mechanisms governing the actions of estradiol during the menstrual cycle on food intake and energy expenditure and how estradiol acts with other weight-controlling molecules such as GLP-1. GLP-1 analogs have proven to be effective both to manage obesity and T2D in women. This review also highlights the relationship between steroid hormones and women's mental health. It explains how a decline or imbalance in estradiol levels affects insulin sensitivity in the brain. This can cause cerebral insulin resistance, which contributes to the development of conditions such as Parkinson’s or Alzheimer’s disease. The proper use of both estradiol and GLP-1 analogs can help to manage obesity and preserve an optimal mental health in women by reducing the mechanisms that trigger neurodegenerative disorders.
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A plethora of studies to date has examined the roles of feeding-related peptides in the control of food intake. However, the influence of these peptides on the intake of particular macronutrient constituents of food – carbohydrate, fat, and protein – has not been as extensively addressed in the literature. Here, the roles of several feeding-related peptides in controlling macronutrient intake are reviewed. Next, the relationship between macronutrient intake and diseases including diabetes mellitus, obesity, and eating disorders are examined. Finally, some key considerations in macronutrient intake research are discussed. We hope that this review will shed light onto this underappreciated topic in ingestive behavior research and will help to guide further scientific investigation in this area.
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The Leeds Food Preference Questionnaire (LFPQ), a computer-based task for measuring reward responses (liking/wanting) and preferences for images of food, is a widely used tool. However, no cultural adaptation studies to date have addressed its validity and repeatability in a test-retest design. The present study aimed to develop a Japanese version of the LFPQ (LFPQ-J); examine its outcomes under fasted and fed states; and test its reproducability after one week. An online survey containing foods that were either low-fat sweet, high-fat sweet, low-fat savoury or high-fat savoury was first conducted among a sample of 200 Japanese adults (100 men and 100 women) to develop and validate a culturally appropriate food image database. Sixty participants (30 men and 30 women) then participated in two identical trials where they completed the LFPQ-J under fasted and fed states (immediately after a standardised meal), at least one week apart. The absolute difference within the participants in scores for explicit liking, explicit wanting, implicit wanting and relative preference between the trials was analysed using Bland-Altman plots and Pearson’s or Spearman’s correlation coefficients. In the fasted state for each food category, 91.1 to 96.4 % of the data were plotted within the 95% limits of agreement and intra-personal correlation were 0.58 - 0.81. In the fed state for each food category, 91.1 to 98.2 % of the data were plotted within the 95% limits of agreement and intra-personal correlation were 0.40 - 0.83. The present study demonstrates that the LFPQ-J is a sensitive and reproducible instrument for the evaluation of liking and wanting for food varying in fat content and sweet taste in Japanese adults.
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Although its etiology is unknown, it has been hypothesized that premenstrual syndrome (PMS) is linked to a deficiency of central serotoninergic activity. In the present study, we evaluated the effect of fluoxetine, a specific serotonin uptake inhibitor, on PMS symptoms. Following extensive screening, including several psychological inventories, eight women with severe persistent PMS participated in a 6-month double-blind, placebo-controlled, crossover study which included three months each of daily fluoxetine 20 mg or placebo, administered in a randomized order. Symptoms were evaluated using the Calendar of Premenstrual Experiences and other psychometric measures. Compared with placebo, treatment with fluoxetine was associated with an improvement in PMS symptoms as judged by highly significant decreases in behavioral (P less than .005), physical (P less than .05), and total (P less than .005) Calendar of Premenstrual Experiences scores; Beck Depression Inventory scores (P less than .005); Profile of Mood States subscales scores including depression (P less than .005), tension (P less than .005), and anger (P less than .01); and State-Trait Anxiety Inventory scores. The use of fluoxetine was associated with a greater mean reduction in behavioral (75%) than in physical scores (40%), with a mean decrease in total Calendar of Premenstrual Experiences scores of 62%, which rendered these scores similar to follicular phase values. Thus, the luteal phase symptomatology of PMS was effectively abolished. At this dose, no significant side effects or complications were noted during treatment. Fluoxetine appears to be a highly effective, well-tolerated treatment for the psychological and physical symptoms accompanying severe PMS.
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The effect of menstrual cycle phase on dietary intake and body weight was investigated in nine healthy females. Daily food intake, basal body temperature and body weight were determined throughout one menstrual cycle. Mean daily caloric intake as well as protein, carbohydrate, fat, and calcium intakes during the follicular phase were compared to those during the luteal phase. No significant difference in any mean nutrient intake was found between the two cycle phases. Subjects showed various individual patterns of food intake and body weight fluctuation. No characteristic pattern of body weight change or nutrient intake was observed for the group.
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Pyridoxine and magnesium status of nine women with premenstrual syndrome was compared with that of ten asymptomatic women. Three-day food intake records were analyzed for selected nutrients in both the pre- and postmenstrual phases. Plasma magnesium was the measure of magnesium status, while plasma pyridoxal phosphate and erythrocyte aspartate aminotransferase stimulation were used to evaluate pyridoxine status. Average magnesium intake was significantly higher among controls in the premenstrual phase, but there was no significant difference in plasma magnesium levels between the two groups. Pyridoxine intakes did not differ significantly between groups during either phase of the menstrual cycle, and both groups showed adequate pyridoxine status according to biochemical measures. A significant positive correlation was found between aspartate aminotransferase stimulation and ratings of both anxiety related symptoms (p=0.078) and fluid retention symptoms (p=0.0001).
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Observations during the rhesus menstrual cycle confirmed that adjustments in food intake accompany changes in ovarian condition and indicated progesterone antagonism of estradiol's ability to suppress primate feeding. Food intake was significantly higher during the luteal phase, when progesterone is high and estradiol low, than during the early follicular phase, when levels of both these hormones are low. To test antagonistic effects of progesterone, ovariectomized females given 4 consecutive daily injections of either 15 mg progesterone or vehicle received 20 μg estradiol benzoate on the second and third treatment days. Progesterone did not modify the decline in feeding and body weight which followed this acute estradiol treatment. In an additional study, females chronically stimulated by subdermal estradiol capsules showed no systematic changes in food intake or body weight when injected for 9 days with 15 mg/day progesterone. This treatment did reduce sexual activity during heterosexual mating tests. These females also responded to 15 mg/day dihydrotestosterone propionate with significant weight gains. A fourth study showed that progesterone treatment of 15 mg/day is adequate to raise circulating levels in ovariectomized rhesus above those of intact females. Overall, these studies failed to confirm a role of progesterone in the adjustments of food intake which accompany changes in ovarian condition of primates.
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A review of evidence indicates that experimentally induced changes in the activity of serotonin (5-hydroxytryptamine) systems are associated with pronounced changes in feeding behaviour. In general, treatments and procedures believed to lead to an increased availability of 5-HT in the synaptic cleft or which directly activate 5-HT receptors reduce food consumption, while procedures which either directly or indirectly decrease 5-HT receptor activation bring about the opposite effect. Interpretation of findings is hindered by methodological difficulties involved in the experimental manipulation of serotonin metabolism, by the lack of precise behavioural measures of feeding, and by the presence of large stores of serotonin outside the brain. However, available data favour the idea that serotonin systems play an inhibitory role in feeding, possibly in the mediation of satiety. This proposal has implications for further experimental investigations of the control of food intake, and for the aetiology and treatment of obesity.
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Based on previous research on the effects of emotional arousal on eating behavior, it was predicted that clinical depression would not result invariably in appetite suppression and weight loss. Normally restrained eaters were expected to show weight gain as a consequence of emotional distress, whereas normally unrestrained eaters were expected to show the traditionally predicted weight loss. Nine female and 3 male 21-44 yr old clinically depressed patients were designated as restrained or unrestrained eaters, and it was found that the former tended to gain weight (as indicated in self-reports) in conjunction with their depression while the latter tended to lose weight. It is concluded that weight changes bear a complex but systematic relation to emotional distress and well-being. (PsycINFO Database Record (c) 2012 APA, all rights reserved)