Two artificial sweeteners aspartame and saccharin currently dominate the American market. Aspartame is the newer of the two. It is manufactured from phenylalanine and aspartic acid, two different amino acids. Though many women tolerate aspartame well, some do not. Many of my PMS patients or patients with generalized anxiety or food allergies find that aspartame intensifies anxiety and nervous tension, worsens "the jitters," and even can trigger a rapid heartbeat. In addition, people with phenylketonuria (PKU) are born without the enzyme needed to metabolize phenylalanine. They cannot digest the large amounts of phenylalanine found in the myriad of artificially sweetened soft drinks, desserts, and dietetic foods that are ubiquitous in our society (as well as food naturally high in phenylalanine). People born with this genetic problem find that phenylalanine ingestion triggers headaches, dizziness, mood swings, and other symptoms. On the positive side, however, aspartame is probably the safest artificial sweetener on the market. Since it is 200 times sweeter than table sugar, people need very little to achieve desired culinary results.

The other artificial sweetener currently on the market is saccharin. While it has been used for many decades, much research suggests that it may be mildly carcinogenic in animals. Saccharin, too, is quite sweet and, in fact, is 300 times sweeter than sugar (although it does have a slightly bitter aftertaste). Saccharin contains no calories whatsoever, and, until the advent of aspartame, was the main artificial sweetener used by millions of Americans trying to lose weight. However, because of the health concerns regarding its use, the U.S. Food and Drug Administration (FDA) has been trying to remove it from the marketplace for many years. As of this writing, it can still be purchased freely in most supermarkets.

A third type of sweetener called cyclamates was actually banned from the market in 1969. Packaged under the brand name Sucaryi, it was a very popular type of artificial sweetener used throughout the 1960s. Laboratory tests found that high dosages of cyclamates produced bladder cancer in research animals.

No artificial sweetener currently on the market is without drawbacks or potential health hazards. It is best to use utilize natural sweeteners in small amounts if you are concerned about potential side effects of artificial sweetners or if you find that you do not tolerate them at all.

• Anxiety and panic episodes
  
• Bulimia
  
• Candida
  
• Chronic fatigue
  
• Diabetes mellitus
  
• Food addiction
  
• Hypoglycemia
  
• Loss of B vitamins and minerals
  
• Menopausal mood and low energy symptoms
  
• Obesity
  
• PMS-related emotional symptoms and food cravings
  
• Tooth decay and gum disease

• Beverages: soft drinks, mixed sweet drinks
  
• Convenience foods: salad dressing, catsup, relish
  
• Desserts: cookies, candies, cakes, pies, ice cream
  
• White flour products: pasta, bread, crackers, pastries

Salt
Many foods like cheese and meat, as well as salt flavored condiments such as table salt and monosodium glutamate (MSG), generally contain large amounts of sodium. Sodium is one of the body's major minerals. It is found primarily in the body's extracellular compartment and in the fluids within the vascular compartments. The rest is stored within the genes. Along with potassium, the primary intracellular mineral, sodium helps to regulate the cell's water balance. Water tends to accumulate in areas where sodium collects. Thus, an overabundance of sodium in relationship to the body's potassium levels can lead to edema, bloating, and even some cases of high blood pressure.

During the active reproductive years, ingesting too much salt can worsen premenstrual bloating, fluid retention, and breast tenderness during the week or two prior to the onset of menstruation. It can also worsen the dull aching pain that can accompany menstrual cramps at the beginning of the menstrual period. With the onset of menopause, excess sodium intake is a risk factor for many other health problems like cardiovascular disease and hypertension. Women at high risk for developing these problems should certainly curtail their sodium intake.

Bloating and fluid retention are very common in menopausal women. Fluid retention often adds to the excess pounds that can be so irksome; many women complain that they gain 10 to 15 pounds after menopause and that the weight is very difficult to lose, even with dieting and exercise. Of even greater concern is the fact that excess sodium is a risk factor for osteoporosis, since it accelerates calcium loss from the body.

Besides regular table salt, MSG, another sodium containing flavor enhancer, has been implicated in health problems. MSG is often used in food preparation in Chinese restaurants. It is also a common ingredient in many commercial seasonings, meats, condiments, and oven baked goods. Besides causing headaches and anxiety episodes, this chemical seems to worsen my patients' food cravings and food addictions.

Unfortunately, avoiding salt and MSG in the American diet, like sugar, takes some work because it is so prevalent. In fact, salt and sugar are often found together in large amounts in frozen, canned, cured, and processed foods. Many of us eat so much salt (far beyond the recommended 2000 mg or one teaspoon per day) that our palates have become jaded. Many people feel that food tastes too bland without the addition of salt. Fast foods such as hamburgers, hot dogs, French fries, pizza, and tacos are loaded with salt and saturated fats. Common processed foods such as soups, potato chips, cheese, olives, pickles, salad dressings, and catsup (to name only a few) are also heavily laden with salt. One frozen food entree can contribute as much as one half teaspoon of salt to your daily intake. And if this was not bad enough, many people use the salt shaker liberally in their own cooking and seasoning.

Fortunately, there are many other seasoning options available that are much better for your health. For flavoring, use garlic, basil, oregano, and other herbs. The fresh foods that we eat such as vegetables, grains, legumes, and meat contain all the salt we need, so added table salt isn't necessary. As with sugar, it is important that you read the labels before you buy bottled, canned, or frozen food. Don't buy a product if salt is listed as a main ingredient (near the top of the label). Many brands in the health food stores and supermarkets now distribute foods labeled "no salt added" or "reduced salt." Be sure to buy these rather than the high-salt foods. If you are sensitive to MSG, be sure to check labels of bottled salad dressings and sauces to make sure that it is not an ingredient. Also, eat at Chinese restaurants that advertise "No MSG" in their ads or in their windows. Many restaurants are aware of the reactions that people have to MSG, so they forego using it in food preparation. Be knowledgeable about the salt substitutes available in natural food stores like miso (flavored soy paste of Japanese origin) or Bragg's Liquid Amino Acids. These and other foods impart a salty taste with less sodium. Also, eat plenty of fresh fruits and vegetables since they are excellent sources of potassium and other essential nutrients. Potassium helps balance the sodium in the body and regulate the blood pressure to keep it at normal levels.

Red Meat, Eggs, and Dairy Products
Red meat (such as beef, pork, and lamb), eggs, and dairy products (such as butter, cream, milk, yogurt, and ice cream) are the main sources of saturated fats in the typical American diet. These fats are solid at room temperature and tend to be more stable and become rancid more slowly than the healthier polyunsaturated fats. Unlike polyunsaturated fats (found primarily in vegetable sources such as raw seeds and nuts, green leafy vegetables, and fish), saturated fats can contribute to such common health problems as heart disease, cancer, obesity, and arthritis. Unfortunately, 40 percent of the calories in the American diet come from these unhealthy, meat-derived saturated fats. The American breakfast of eggs, bacon, milk, toast and butter, as well as dinner choices like hot dogs, hamburgers, pizza, and milk shakes, are loaded with saturated fats.

During the active reproductive years, a diet high in saturated fat increases the risk of menstrual cramps, PMS, ovarian cysts, benign breast disease, endometriosis, fibroid tumors of the uterus, heavy menstrual bleeding, and other female health problems. Changing the diet can be difficult for women because meat and dairy products have traditionally been touted as important food groups. Most women consider them the mainstay of their diets, consuming large amounts of cheese, yogurt, milk, cottage cheese, eggs, and meat. Yet meat and dairy products are the main dietary sources of arachidonic acid, the fat that your body uses to produce the series-2 prostaglandin hormones. These hormones are the main culprits implicated in causing the painful menstrual cramps experienced by 50 percent of all younger American women. In my practice, I have seen the severity of menstrual cramps decrease by as much as one third to one half within one menstrual cycle when women completely eliminated these foods from their diet. Also, the high salt content of dairy products increases the bloating and fluid retention usually seen one to two weeks before the onset of menstruation in women suffering from PMS. In postmenopausal women, arachidonic acid derived PGE 2 increases the risk of many health problems emerging during the later years. It actually promotes platelet aggregation or clumping, thereby initiating potentially dangerous clot formation. It also causes inflammation and fluid retention, which can predispose postmenopausal women towards arthritis and high blood pressure.

Besides increasing the levels of the harmful series 2 prostaglandin hormones, the regular use of dairy products, red meat, and eggs also increases estrogen levels in the body. In fact, the blood estrogen levels found in omnivores differs strikingly from those of vegetarian women who eat a lowfat, highfiber diet. Specifically, omnivores have 50 percent higher blood estrogen levels and only one third to one half the blood estrogen excretion rates of vegetarian women. Studies conducted at Tufts University Medical School explained why this is the case. Researchers found that under optimal dietary conditions, large amounts of dietary fiber (normally found in fruits, vegetables, grains, and legumes) bind with estrogen, aiding its excretion from the body in the bowel movements. This helps to regulate the blood estrogen levels and keep them from rising too high. Predictably, women eating a high fat, low fiber diet have higher blood levels of estrogen. Fat promotes the growth of intestinal bacteria that can act chemically on estrogen metabolites, reactivating them so that they can be reabsorbed back into the body. Elevated levels of estrogen can worsen a variety of female complaints, including PMS, fibroid tumors of the uterus, heavy menstrual bleeding, endometriosis, and benign breast disease.

As women reach midlife, the use of meat, eggs, and dairy products can promote a host of other health problems. Saturated fat tends to increase the cholesterol levels in the blood, particularly the high risk, low density lipoproteins that initiate plaque formation in the blood vessels. Plaque formation can eventually lead to heart attacks and strokes. In contrast, the "good" fats derived from fish and vegetable sources can actually prevent heart attacks by reducing the tendency for the blood to clot. A high saturated fat diet can also lead to obesity in women of all ages. Menopausal women are particularly at risk since, as their metabolism slows down with age, they burn calories less efficiently. One gram of fat contains 9 calories versus the 4 calories contained in one gram of protein or carbohydrate. As a result, fatty foods tend to be much higher in calories per unit weight. While saturated fats do provide the body with a concentrated source of energy, very few of us need these extra calories. Instead of burning the fat for energy, we tend to store it in our cells as excess pounds.