The great progesterone pioneer Dr. Katharina Dalton, who successfully improved the quality of life thousands of women -including many difficult cases with neurologic problems- by improving progesterone function in them, didn't seem to be very fond of low-carb and starvation / low calorie kind of diets and lifestyles. I got an understanding from her book "Once a Month" about her requirement of specific dietary measures for her patients -and it was with huge success-. The biochemical/metabolic "rules" to improving progesterone function Dr. Dalton makes it very clear in her book that the treatment-plan for restoring the progesterone hormonal function in a woman must focus first and foremost on fixing the diet in such a way that: 1) Cells, at all cost, must not be deprived from or run out of of sugar 2) Adrenaline is kept as low as reasonably possible, not allowed to spike. As you may see 1) and 2) are closely related since when tissues are deprived from sugar, there usually comes an adrenaline response. Also, when adrenaline gets high, the blood gets flooded with free fatty acids, which in turn block the cells ability to metabolize glucose (Randle cycle). So 1) and 2) create a vicious cycle. Dr. Dalton provides the following explanations for the above "rules":"progesterone receptors cannot transport or bind to, a molecule of progesterone if there has been a drop in blood sugar""progesterone receptors do not transport progesterone molecules into the nucleus of cells if adrenaline is present".Diet: the main focus for progesterone problems and therapy Based on the aforementioned biochemical/metabolic considerations, she designed a diet to accompany the progesterone treatment, calling it "The Three-Hourly Starch Diet". This diet has the following characteristics:Frequent carb snacking: "divide the day's starchy food so that you eat small starchy snacks every three hours during the waking hours and within one hour of waking and retiring to bed" [Note: she was fine with grains as a carb source.]Minimizing overnight fast: "Ideally, the overnight fast should not exceed ten hours"Overall diet: "Meanwhile, continue with a healthy diet with adequate protein and plenty of fruits and vegetables"An ongoing practice: "Continue the diet throughout the menstrual cycle"The diet "incubation" period and the risk of progesterone failure if the diet is not thoroughly followed: "It takes at least seven days before the benefit of frequent eating is appreciated, and unfortunately, if there are long gaps between eating and snacking it will take up to seven days to recover. ... I does not matter if you don't eat every hour or two as ling as you don't wait longer than three hours."Preparation to supplementation: "Before starting progesterone treatment ... Ensure that the patient has maintained the Three-Hourly Starch Diet for at least one week".In fact, the diet is at the core of any program trying to improve progesterone function, more important than any progesterone supplementation itself. She boldly stated: "...the Three-Hourly Starch Diet... by itself will relieve many of the symptoms of PMS; without this diet progesterone is not effective."Also:"I would firmly start all patients on the three hourly starch Diet before prescribing progesterone" Some patients cured by diet alone There are records of patients whose PMS was cured by diet alone!: "When each patient returned her food forms, she was given advice about the Three-Hourly Starch Diet and advised to continue with it until her appointment. During the interval, several canceled their appointment, thanking us, because the diet alone had solved their problems; others came only to thank us as they did not need further help." Women's eating habits: past and present In 1948, Dalton had her first six patients who responded to progesterone therapy for PMS. She explains that a typical 1948 woman was a housewife who spent lots of their time cooking, who "would have been nibbling all day. The well-heeled ladies had their breakfast, morning coffee, lunch, afternoon tea, supper, and a snack before bed to prevent night starvation.'" She also makes the connection that "It was before the Twiggy era [the first world's supermodel], and before health education advised everyone to lose weight. ... There were no fast foods, no convenience food ..." Differentiating between PMS and Menstrual Magnification/Distress The PMS definition as given by Dalton requires that symptoms recur before menstruation, and are completely absent after menstruation. In contrast, in menstrual magnification or menstrual distress there is no absence of symptoms after menstruation, just a reduction in severity. Dalton pointed out that the patients that were more likely to highly benefit from the diet measures were the PMS patients, but that the Menstrual Magnification/Distress patients diet can still benefit and should follow it. Note: Regarding the frequent snacking, she explained that it was more of a women's need; she said men [I assume healthy ones] can usually go longer without food, which is in line with what Peat says about women's typically lower liver and thyroid function as compared to men. Katharina Dalton was definitely on to something. Hopefully we as women will be able to make better dietary choices and not fall for fads and tricks that can damage our well-being.