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Dietary changes can and do make a difference in PMDD and PMS (1).
Specifically, a “Western-style” diet is associated with PMS along with snacking a lot on breads and refined carbohydrates (1,2).
What the hell even is a “western-style” diet?
Diets in the west can be incredibly variable, so we have to look at the common denominator in what distinguishes a “Western-style” diet from a more traditional or ancestral diet.
In one case control study that looked at dietary association and premenstrual symptoms, they described a “western style diet” as “high loading of fast foods, soft drink, processed meats, salt, salty snacks, sugar-sweets-desserts, organ meat, broth, poultry-skin, hydrogenated fats, mayonnaise, high fat diary, vegetables oil, tea and red meat” (3).
I really don’t know anyone in our current culture (besides myself) that eats a “high loading” of organ meat, firstly. Secondly, in this study, we see that a “traditional diet” which also had a good amount of red meat in it was associated with a lower odds of premenstrual symptoms (3).
I don’t think it is the red meat in the diet that defines a “western-style” diet then OR the organ meats OR the saturated fats.
In general, I will say firstly that I don’t love nutritional studies because people aren’t great at remember what they eat and without an interventional trial, it is hard to tell if those with PMDD are simply craving more carbohydrates and snacks and that is why it shows in this trial that they eat more bread and snacks or if that pattern of eating is actually causing these premenstrual symptoms.
Also in the review I cited above (1), there are often multiple interventions being done and in some of the interventions (e.g. following a specific diet for a few months), there were no changes in premenstrual symptoms (1).
We do know, though, that there are certain intakes of nutrients, specifically, calcium that are associated with a decreased risk of PMS, and so those who take in more dairy and have a higher calcium intake are less likely to to have PMS/PMDD symptoms (1,4).
Those with the highest tertiles of vitamin D and calcium intake had the lowest odds of PMS, though the results in this study were not significant (4).
So many women I see who have premenstrual symptoms are avoiding milk for one reason or another (now some people are actually allergic to milk or cannot tolerate it, that is different) and they avoid sun like the plague.
Truly you need calcium and vitamin D for physical and mental health.
Other studies have shown that high intakes of carbohydrates, fats, salt, and alcohol and low intakes of B vitamins, vitamin D, zinc, calcium, and omega-3 fatty acids are associated with increased prevalence of PMS (5).
In one case control study, fruit was associated with a decreased risk of PMS symptoms (6) while in other studies, a diet rich in processed/red meat (now these are often lumped together in studies which I think is not helpful because unprocessed red meat is a rich source of important nutrients for premenstrual symptoms), fast food, vegetable oil, mayonnaise, deep-fried foods, salty snacks, refined grains, sugar and soft drinks, high-fat dairy products, spices, and fried potatoes are associated with an increased risk of PMS symptoms (7).
As I've said, I’m not a big fan of observational nutritional studies because they usually rely on food recall which is highly flawed and there is often a healthy user bias that confounds this (e.g. maybe people who eat out more are more likely to struggle with chronic stress or people who eat red meat are more likely to drink alcohol?).
Because we can see that a Western-style diet is probably not ideal for premenstrual symptoms, let’s take a look at what makes a Western diet different from other sorts of diets.
Firstly, we will take a look at the fats first because we do know that of all of the dietary changes that has happened in the west over the past 100 years, the proportion of the omega 6 fatty acids we’ve been eating has increased by quite a bit (8).
Fats are essentially long chains of carbon atoms with hydrogen atoms bonded to the carbons along this chain.
The different types of fats are:
1. saturated
2. polyunsaturated
3. monounsaturated
4. trans fats
What differentiates these types of fats is whether or not they are fully or somewhat covered with hydrogen atoms.
Saturated fats are fully saturated and covered with hydrogen atoms, monounsaturated fats lost a couple of hydrogen atoms leading to one double bond between two of the carbon atoms, and polyunsaturated fats have lost more hydrogen atoms than monounsaturated fats and have multiple carbons connected to one another through a double bond.
Trans fats are a type of unsaturated fats that are bent a bit differently than other unsaturated fats, and so simply have a different configuration than other unsaturated fats.
Polyunsaturated fats are more fragile than monounsaturated and saturated fats and can more easily oxidize which means they lose an electron.
This can damage other important molecules in our cells.
Polyunsaturated fats can further be divided into omega 6 fatty acids and omega 3 fatty acids.
Although these fats are fragile and can oxidize easily, they are likely needed in small amounts in the body.
Omega 6 fatty acids do help create inflammatory molecules that we need in order to stop bleeding, react appropriately to viruses, and also produce prostaglandins (which are responsible for pain, especially pain during periods).
In contrast, omega 3 fatty acids create anti-inflammatory molecules that counteracts those inflammatory molecules.
We need a balance of omega 3 and omega 6 fatty acids and some have argued that it is ideal to have a 4:1 ratio of omega 6 fatty acids to omega 3 fatty acids and that’s what our ancestors would have had (9).
Animal studies have shown that increases in linoleic acid in the diet (which is a type of omega 6 fatty acid) increases circulating estrogen in the blood (10).
Interestingly, higher intake of EPA and DPA (omega 3 fatty acids) are also correlated with increases in estrogen levels (which tends to exacerbate PMS symptoms) (11).
However, this is in some contradiction with RCT’s showing that omega-3 fatty acids may decrease the severity of PMS, but this seems to depend on how long they are used (11).
It is unclear therefore whether omega 3 fatty acids truly benefit premenstrual symptoms or if it improves the omega 6 to omega 3 fatty acid ratio. We do know, though, that in the Western world today, the amount of omega 6 we have been consuming has significantly increased, particularly compared to the amount of omega 3 fatty acids that we consume (9).
This is due primarily to the seed oils (canola, soybean, grape seed, peanut, and cottonseed oils) that have been more recently introduced to our diet, and specifically, soybean oil has increased in our diet over 1000 fold in the past century (8).
These oils (especially soybean) all have significant amounts of Linoleic acid which is a type of omega 6 fatty acid, and soybean oil is more often found in the nebulous “vegetable oil”, processed foods (which is basically anything in a package that you wouldn’t find in nature, especially salad dressing!), and food cooked at a restaurant.
I strongly believe it is the addition of these oils with the resulting substantial increase in linoleic acid in our diet, as well as refined carbohydrates and sugars, are what differentiate a “Western-style” diet from say, a more traditional diet, regardless of what it is.
We also need to address the refined carbohydrates and sugars that seem to be prevalent in a “Western-style” diet.
As mentioned above, we do see in one case control study, that a diet high in refined carbohydrates was associated with premenstrual symptoms— in fact, having a diet high in breads/carbohydrates (specifically, “snacks” which encompassed cookies, cakes, etc.) in this study was associated with a 2.59 times higher risk of premenstrual symptoms (2).
When people remove refined carbohydrates from their diets, they inherently remove a lot of processed foods as well and by extension, a lot of seed oils/vegetable oils. However, in this case control study, there wasn’t a significant difference between omega 6 content of the diet between those with PMS and those without (2).
This study also takes place in South Korea, so the dietary patterns are likely different than the US (e.g. it looked like in this study that the omega 6 content in their diet was around 5% which is less than ours at 7+%).
In the other case control study I’m citing (see reference 3), the subjects that had a higher adherence to the “Western-style diet”, had a higher amount of linoleic acid as well as saturated fats and monounsaturated fats and lower amounts of B vitamins, zinc, calcium, magnesium, vitamin C, and vitamin D (3).
I’m not convinced that it is the fats that are bad per se but I do think that compared to our ancestral diets (e.g. diets we ate as hunter gatherers and in traditional cultures), we are eating significantly more linoleic acid given the introduction of seed oils in the late 1800’s/early 1900’s (8).
It is very difficult to point to linoleic acid as the main culprit for premenstrual symptoms but given that supplementing various nutrients (B vitamins, calcium, vitamin D, etc.) seems to be helpful for premenstrual issues, I suspect that these processed foods are crowding out more nutrient-rich foods in the diet.
This is why I have “beef” (pun intended) when studies point to red meat as contributing to premenstrual symptoms since it is part of a “western diet”.
Red meat has a plethora of nutrients including nutrients that in studies are shown to be beneficial for premenstrual symptoms (5).
If you want to significantly reduce the linoleic acid in your diet, stop eating processed foods (e.g. nothing from a package essentially or any salad dressings, etc.) and stop eating fast food or food from restaurants in general.
Easier said than done.
I rarely eat out these days and if I do, I try to find a restaurant that cooks in butter or tallow or I get something raw like a simple sushi or sashimi without any sauces.
Sauces like mayonnaise or salad dressings also have seed oils in them and so I avoid those as well (so that means I don’t eat salads, essentially, gasp).
They also aren’t nutrient rich and crowd out other foods that could give me a bigger bang for my buck.
It can seem quite restrictive to cut out these things but if you want to see change, especially change from the typical American health, you often have to make radical changes.
References:
1. Robinson J, Ferreira A, Iacovou M, Kellow NJ. Effect of nutritional interventions on the psychological symptoms of premenstrual syndrome in women of reproductive age: a systematic review of randomized controlled trials. Nutr Rev. 2025;83(2):280-306. doi:10.1093/nutrit/nuae043
2. Kwon YJ, Sung DI, Lee JW. Association among Premenstrual Syndrome, Dietary Patterns, and Adherence to Mediterranean Diet. Nutrients. 2022;14(12):2460. Published 2022 Jun 14. doi:10.3390/nu14122460
3. MoradiFili B, Ghiasvand R, Pourmasoumi M, Feizi A, Shahdadian F, Shahshahan Z. Dietary patterns are associated with premenstrual syndrome: evidence from a case-control study. Public Health Nutr. 2020;23(5):833-842. doi:10.1017/S1368980019002192
4. Nanri A, Sakanari M, Mantani H, et al. Calcium, Vitamin D, and Dairy Intake and Premenstrual Syndrome: A Cross-Sectional Study. J Nutr Sci Vitaminol (Tokyo). 2025;71(2):155-162. doi:10.3177/jnsv.71.155
5. Oboza P, Ogarek N, Wójtowicz M, Rhaiem TB, Olszanecka-Glinianowicz M, Kocełak P. Relationships between Premenstrual Syndrome (PMS) and Diet Composition, Dietary Patterns and Eating Behaviors. Nutrients. 2024;16(12):1911. Published 2024 Jun 17. doi:10.3390/nu16121911
6. Farasati N., Siassi F., Koohdani F., Qorbani M., Abashzadeh K., Sotoudeh G. Western dietary pattern is related to premenstrual syndrome: A case-control study. Br. J. Nutr. 2015;114:2016–2021. doi: 10.1017/S0007114515003943.
7. Freeman E.W., Stout A.L., Endicott J., Spiers P. Treatment of premenstrual syndrome with a carbohydrate-rich beverage. Int. J. Gynaecol. Obstet. 2002;77:253–254. doi: 10.1016/S0020-7292(02)00033-4.
8. Blasbalg TL, Hibbeln JR, Ramsden CE, Majchrzak SF, Rawlings RR. Changes in consumption of omega-3 and omega-6 fatty acids in the United States during the 20th century. Am J Clin Nutr. 2011;93(5):950-962. doi:10.3945/ajcn.110.006643
9. DiNicolantonio JJ, O’Keefe J. The Importance of Maintaining a Low Omega-6/Omega-3 Ratio for Reducing the Risk of Autoimmune Diseases, Asthma, and Allergies. Mo Med. 2021;118(5):453-459.
10. Hilakivi-Clarke L, de Assis S, Warri I. The influence of maternal diet on breast cancer risk among female offspring. Nutrition. 1999;15(5):392-401. doi:10.1016/S0899-9007(99)00029-5
11. Guo L, Nan Y, Liang K, Yao L, Li J. Association between polyunsaturated fatty acid intake and estradiol levels among U.S. women. Front Nutr. 2024;11:1500705. Published 2024 Nov 20. doi:10.3389/fnut.2024.1500705
12. Oboza P, Ogarek N, Wójtowicz M, Rhaiem TB, Olszanecka-Glinianowicz M, Kocełak P. Relationships between Premenstrual Syndrome (PMS) and Diet Composition, Dietary Patterns and Eating Behaviors. Nutrients. 2024;16(12):1911. Published 2024 Jun 17. doi:10.3390/nu16121911