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Addressing Women’s Changing Health Needs
Discovering how nutritional ingredients can support the fairer sex

by Heather Granato

Throughout the ages, women have been alternately worshiped, feared, honored and ridiculed for the innate physical changes and powers all women face in their lives. However, there is growing interest in gender-specific medicine that addresses women’s particular health needs.

“While regular exercise, a balanced diet and nutritional support are critical for maintaining health, genderspecific nutritional products can address the hormonal, metabolic, biochemical and general physiological needs of men and women,” said Theresa A. Sehi, D.C., president of Herbotanix. “When there is disruption of normal functioning and symptoms occur—as typically occurs in conjunction with periods of hormonal change—gender-specific nutritional products with therapeutic activity can be especially effective.”

The best first view of women’s health may be from the vantage point of hormonal influence. While men enter their teen years on a surge of testosterone—one that often never fully abates—from the time women start menarche, their bodies face constant fluctuations of sexual hormones throughout their lives. Among those critical hormones are estrogen, which is responsible for guiding a woman’s body through pregnancy; progesterone, which works with estrogen on conception and regulates menstruation; luteinizing hormone (LH) and follicle stimulating hormone (FSH), which both impact ovary follicle maturation; and androgen, which stimulates growth at puberty then falls off dramatically at menopause. The circle of sexual fertility starts, on average, in the early teen years and comes to a halt in the early 50s.

And it’s not just your customers’ imagination; those hormonal fluctuations do have a serious impact on physiology and mood on a monthly basis for most women. In fact, it is estimated that at least 85 percent of menstruating women suffer from at least one physical and/or emotional symptom of premenstrual syndrome (PMS).

In the realm of basic nutrition, a case-control study nested within the prospective Nurses’ Health Study II cohort found women with the highest intake of vitamin D had almost half the risk of PMS of those in the lowest quintile; high calcium intake produced a 30-percent risk reduction.¹ And a review in Nutrition noted calcium supplementation appears to significantly reduce the physical and emotional symptoms of PMS, and even suggested PMS could be a predictor of osteoporosis induced by low calcium intake.² And calcium’s partner magnesium may also support menstrual health, as administration of 200 mg/d plus 50 mg/d of vitamin B6 was found in one study to significantly reduce anxiety-related PMS symptoms, including mood swings and irritability.³

Natural treatments may also help women address pain connected with dysmenorrhea (severe pain and blood loss with menstruation) and other uterine complaints. Administration of 30 mg/twice daily of French maritime pine bark extract (as Pycnogenol®, from Natural Health Science) to 47 women with dysmennhorea led to significant relief of abdominal and back pain after three months of treatment.⁴ Administration of 400 IU/d to 500 IU/d of vitamin E to teenage girls suffering primary dysmenorrhea alleviated pain severity and decreased blood loss.⁵

Vitex agnus-castus, better known as chaste tree, is a well-known botanical remedy for PMS. It has been shown efficacious in treating a range of gynecological disorders, including menstrual irregularities, hormone imbalances and cyclic mastalgia.⁶ German researchers examined the impact of Vitex on PMS symptoms including depression, anxiety, craving and edema, and found 93 percent of participants had a reduction in or cessation of symptoms after four months.⁷ Similar results were reported in a Turkish study, in which Vitex positively impacted breast pain and tenderness along with PMS.⁸

As menstruation ceases, declining levels of estrogen and progesterone signal the entry into perimenopause. During this two- to four-year time frame, a woman’s periods become less regular and she may experience menopausal symptoms such as hot flashes and night sweats. According to the National Institute on Aging, common symptoms of menopause include a change in periods, hot flashes, problems with the vagina and/or bladder, sexual dysfunction, sleep problems, mood changes, weight gain, joint pain and memory problems.

Tori Hudson, N.D., founder of Vitanica, noted she has patients who ask what symptoms they can expect and when they will subside. “Unfortunately, you can anticipate the course of an illness in other cases, but you can’t here because it’s not an illness,” she said. “That makes options key because you don’t want that one-size-fitsall approach. Some women will need hormones, some need different types, different dosages. The duration is variable, the intensity of symptoms is variable, and there are infinite possibilities for treatments.”

Hormone replacement therapy (HRT)— a combination of estrogen and progestin, given to women with a uterus, as opposed to estrogen replacement therapy, ERT, for women without a uterus—has served as the main treatment menopausal women have turned to for alleviating such symptoms. However, women are increasingly turning to more complementary or alternative medical (CAM) therapies to treat menopausal symptoms. In fact, the North American Menopause Society (NAMS) suggests women seeking relief from mild vasomotor symptoms first explore lifestyle changes and/or dietary supplements such as dietary isoflavones, black cohosh or vitamin E.⁹

Possibly the best known of those alternative remedies is black cohosh (Actaea racemosa, syn. Cimicifuga racemosa). Researchers at the University of Illinois Chicago (UIC) NIH Center for Botanical Dietary Supplements Research note black cohosh appears to alleviate menopausal symptoms such as hot flashes, profuse sweating, insomnia and anxiety at a dosage of 40 to 80 mg/d, without estrogenic activity, making it safe for women with estrogen-related cancer concerns.¹⁰

“Black cohosh is really the foundational herb for menopause,” Hudson said.“Then you can treat the additional dominant symptoms, such as insomnia or anxiety, appropriately.”

The research on black cohosh is compelling. German researchers found 40 mg/d of black cohosh extract provided symptom relief to more than 300 women with climacteric complaints,¹¹ and an Italian study in 64 menopausal women reported 40 mg/d of black cohosh was as effective as traditional HRT treatment in reducing hot flashes.¹² One of the largest trials involved more than 2,000 Hungarian women taking black cohosh extract (as Remifemin®, available from Enzymatic Therapy); after 12 weeks of intervention, favorable decreases were seen in hot flashes, sweating,insomnia and anxiety.¹³

Mary Jane Minkin, M.D., noted she recommends Remifemin to her patients who are interested in alternative menopausal therapies. “Millions of women have taken Remifemin, and it has an excellent safety profile,” she said. “In addition, it has significant activity against hot flashes and night sweats, and you know exactly what you’re getting as far as the amount of root extract.”

Other menopausal options have some estrogenic activity, which may alleviate the decline in endogenous production. “Phytoestrogens are a key nutrient to support hormonal balance and decrease symptoms during menopause,” said Barbara Levenstein, director of new product development and education at Arkopharma. “Isoflavones found in soy and red clover, and lignans, abundant in flax seed and fiber-rich food, are some of the best sources of phytoestrogens.”

Dutch researchers reported intervention with red clover (Trifolium pratense L.), as Promensil, from Novogen, supplying 80 mg/d isoflavones for 12 weeks produced a 44 percent reduction in hot flashes.¹⁴ Similar findings were reported in an intervention with 53 menopausal women, in whom Promensil supplementation decreased the rate of menopausal symptoms and triglyceride levels.¹⁵ Another multi-center, double blind study found intervention with Promensil reduced the number of hot flashes more rapidly than placebo, though there was no difference at the end of the study in reduction of mean daily hot flashes.¹⁶

“While Promensil was not as good as estrogen at stopping hot flushes, it is better than placebo and works with very few side effects,” said Lila Nachtigall, M.D., director of the Women’s Wellness Program at the New York University Medical Center; Nachtigall has conducted studies using Promensil for menopausal symptoms. “In addition, studies have shown that it doesn’t increase breast density or endometrial lining, suggesting its safety profile. So if a woman is determined not to take estrogen, we can use something like Promensil first.”

Another phytoestrogenic compound is soy isoflavones, which have been studied for their ability to relieve climacteric complaints because of the low reported frequency of hot flushes in Asian cultures, where soy consumption is more prevalent.¹⁷ Soy isoflavone treatment reduced hot flushes by 44 percent in a six-month Brazilian study,¹⁸ and had similar effects in an Italian study when soy isoflavones were given orally (50 mg/d or 75 mg/d) or transdermally (12 mg/d).¹⁹ Specialty formulas of isoflavones have also proven beneficial. For example, an Italian study involving 177 postmenopausal women experiencing five or more hot flushes per day found 50 mg/d of genistin and daidzin (as SoySelect®, from Indena) reduced severity and incidence of hot flushes in only two weeks, and to a greater degree than placebo after six weeks.²⁰ Further research found SoySelect had synergistic effects in reducing hot flushes when combined with HRT.²¹

Red clover and soy are not the only source of phytoestrogens studied for their impact on menopausal symptoms. Another source of phytoestrogens is Polygonum cuspidatum, an herb used in traditional Chinese medicine; its estrogenic effects are attributed to its resveratrol content. In a study of a standardized extract of transresveratrol from Polygonum cuspidatum (as Protykin®, from InterHealth Nutraceuticals), researchers found the extract improved menopausal symptoms such as hot flushes, mood swings and bone strength.²²

Specialty formulas may also positively impact menopausal symptoms. Researchers from Samsung Cheil Hospital, Korea, performed a double blind study on a phytochemical formula that includes Shanzhiside methyl ester, Cynanchum wilfordii and Phlomis umbrosa (as EstroG- 100™, from JLM Marketing); a total of 47 postmenopausal women were included in the study. After three months, there was a significant improvement in hot flashes and vaginal dryness in the EstroG-100 group.

Another study using a combination of Salvia officinalis (sage) and Medicago sativa (alfalfa) in 30 menopausal women with hot flushes found the combination therapy completely alleviated hot flushes and night sweating in 20 women and reduced symptoms in the remainder; the researchers attributed the results to a slight anti-dopaminergic action, positively affecting neurotransmitters.²³ “Lower levels of estrogen in the blood trigger the release of a regulating factor from the hypothalamus to encourage more hormone production from the ovaries,” explained Eileen Sheets, managing director at Bioforce. “Because the hypothalamus acts as the control center for temperature regulation, you can attribute many of the physical symptoms that occur during menopause to the imbalance in that control mechanism as it struggles with its different tasks.”

The use of adaptogens may also assist in menopausal support, as studies on the proprietary formula Femenessence™ from Natural Health International have shown the ability of its active compounds (Lepidium peruvianum Chacon, as Maca-GO™) to help balance levels of LH, FSH, estrogen and progesterone. “Maca-GO primarily works through adaptogenic properties that stimulate the hypothalamus to induce the body to create a healthy, balanced hormonal state for optimal health,” said James Frame, director of operations with Natural Health. “Therefore, it works differently on each woman depending on what stage of life she is at, her own personal biological make-up and individual health.”

Two studies presented at the NAMS 2006 Annual Congress examined Femenessence’s impact on peri- and postmenopausal women. In the first trial, which included 21 peri-menopausal women aged 42 to 52, researchers provided active treatment (2,000 mg/d of Maca-GO) for two months and assessed hormonal changes and menopausal symptoms.²⁴ Intervention alleviated symptoms including hot flashes, night sweats, mood swings and decreased libido, and significantly increased FSH, LH, estrogen and progesterone levels. The second trial included 100 postmenopausal women who received placebo or 2,000 mg/d of Maca- GO for two months; a parallel study was conducted on ovariectomized rats to assess antidepressive and anxiolytic effects.²⁵ In the women, active intervention significantly increased estrogen and reduced FSH levels, and alleviated menopausal symptoms. The animal arm showed Maca-GO had an anti-depressantlike and sedative effect in the ovariectomized rats, with no anxiolytic activity in control animals.

“Femenessence is different because it actually improves levels of all the key hormones,” Frame said. “Unlike estrogen, progesterone and LH, which all decrease production during menopause, a woman’s production of FSH dramatically increases. This increase in FSH is related to many of the adverse symptoms experienced during this stage of life. Femenessence induces physiological harmony through an increase in estrogen, progesterone and LH, while reducing FSH in postmenopausal women as well as contributing to lower cholesterol, increased bone density and helping to substantially alleviate menopausal symptoms including depression and stress.”

Another condition intrinsically linked with women’s health is breast cancer. While not exclusively the domain of women, breast cancer incidence has increased to approximately one in eight women in the United States; every three minutes, a woman in the United States is diagnosed with breast cancer. The National Cancer Institute (NCI) recently estimated that, based on current rates, 13.2 percent of women born today will be diagnosed with breast cancer at some time in their lives.

“The key is to not just offer supplements for breast health but to educate the consumer on how all their lifestyle choices impact their health and their family’s health,” said Stephen Hennessy, cofounder of Ribbon Nutrition. Among the keys to breast cancer prevention he noted were using natural, chemical-free personal care items and household cleansers; avoiding environmental toxins and unnecessary radiation; and selecting high quality, natural and organic foods and dietary supplements.

Among the powerful foods for breast cancer prevention is green tea. One metaanalysis of 13 studies reported green tea consumption lowered the risk of breast cancer significantly,²⁶ while another reported consumption of five or more cups of green tea per day could prevent both breast cancer development and recurrence.²⁷ The active polyphenols in green tea, specifically epigallocatechin gallate (EGCG), have been shown to arrest the breast cancer cell cycle in vitro, delaying tumor incidence.²⁸ It also has the ability to induce apoptosis in breast cancer cells without damaging normal breast epithelial cells.²⁹

Phytoestrogens also have been studied for their impact on breast cancer. For example, a range of animal and epidemiological studies suggests dietary lignans may have anti-estrogenic, antiangiogenic and pro-apoptotic mechanisms to prevent cancer, with the most supportive data seen in prevention of premenopausal breast cancer.³⁰ For example, in a population-based casecontrol study of 1,122 women with breast cancer and 2,036 controls in New York, premenopausal women in the highest quartile of lignan intake had a 34-percent reduction in breast cancer risk compared to the lowest intake group.³¹

“One of the main advantages to supplementation with flaxseed is it provides plant lignans that convert into mammalian lignans—phytoestrogen antioxidants,” said Kristen Trautman, product category manager at Bioriginal.“Plant-based lignans are beneficial in balancing hormone levels, which is valuable in managing menopause, hormone-dependent cancers and contributing to breast health.”

The lignan SDG (secoisolariciresinol diglucoside) is particularly powerful, and has been shown to significantly slow the growth rate of breast cancer, and reduce tumor size and number of tumors. Brevail® is a chemically characterized proprietary extract of flaxseed containing a defined amount of SDG, shown to be beneficial in preventing and treating breast cancer. A study in animals given a breast-cancer causing carcinogen plus a diet with flaxseed oil, flaxseed meal or SDG found all three diets reduced tumor size, but only the SDG diet reduced tumor size and the average number of tumors.³² In a second study, the same researchers fed pure SDG to carcinogen-treated animals and found the treated animals had a 46 percent decrease in number of tumors compared to the untreated animals, with no apparent adverse effects on any other organs.³³

An unpublished study evaluating the bioavailability of Brevail included healthy postmenopausal women who received 25 mg,50 mg, 100 mg and 200 mg of Brevail as a single oral dose. The researchers found the SDG was efficiently converted to enterodiol and then to enterolactone, and blood concentrations increased rapidly after Brevail was taken. The lignans were eliminated from the circulation with a halflife of 10 hour, and when Brevail was taken daily for a week, plasma concentrations of enterolactone and enterodiol were maintained at a steady level, consistent with those previously reported for women who are at low risk for breast cancer.

“A lot of women are taking Brevail for the flax lignans that help with hormonal balance,” said Christine Horner, M.D., a nationally-known surgeon and author, who most recently published Waking the Warrior Goddess: Dr Christine Horner’s Program to Protect Against and Fight Breast Cancer. “Brevail helps to balance estrogen, so one way it lowers the risk of breast cancer is by regulating and lengthening the menstrual period, so women have fewer menstrual cycles.”

There has been some controversy surrounding soy and breast cancer, though most population studies have shown benefits. “Japan has the highest soy intake in the world and the lowest breast cancer rate,” Minkin said. “If these folks who eat more soy than anyone else have the lowest rate, doesn’t that say something for safety? Perhaps they’re eating it earlier in life when breast differentiation is going on, but I don’t think the theory about soy and breast cancer is an issue. However, any breast cancer patients should be getting guidance from their oncologist.”

One recent meta-analysis included 18 epidemiologic studies assessed for soy intake and breast cancer risk, and found high soy intake was modestly associated with reduced breast cancer risk, with the inverse association somewhat stronger in premenopausal than postmenopausal women.³⁴ Further reviews indicate soy protein isolate may protect against breast cancer through multiple mechanisms, including increased mammary gland differentiation, decreased activation of procarcinogens and regulating genes linked to tumor promotion and/or progression.³⁵ Animal trials suggest soy isoflavones may help to reduce breast proliferation and uterine size in a high-estrogen environment, altering estrogen receptor signaling and protecting the breast.³⁶

Another option for soy consumption is fermented soy. Haelan Products, in Woodinville, Wash., produces a fermented soybean beverage, known as Haelan 951. The fermentation process hydrolyzes many of the soybean’s protein into amino acids and metabolites of naturally occurring isoflavones, such as genistein. Formulated to include most of the phytochemicals found in soy, the beverage has been used to reduce adverse side effects of cancer treatment, providing nutritional support during traditional disease treatment.

Also of interest to breast cancer researchers are the crucifers, including broccoli and watercress. “The cruciferous vegetables have several different chemicals in them with very protective effects against breast cancer and other diseases,” Horner said. “It can shut off a key enzyme necessary for breast cancer to grow, has an effect on estrogen receptors in breast cells, and turns on a tumor suppression gene.”

Sehi seconds the role of crucifers, particularly the compound indole-3-carbinole (I3C) and its metabolite diindolylmethane (DIM). “Studies have shown that I3C and DIM act to interrupt the damaged growth cycle in breast tissue, help restrain proliferation, eliminate damaged cells and help repair genetic material within breast cells,” she said.

Further, I3C has the ability to help the body balance out estrogen when it is processed by the liver to preferentially produce 2-hydroxy-estradiol, the “good” estrogen versus 16-hydroxy-estradiol, which has more negative consequences. “By enhancing the production of the ‘good’ estrogen, women get a stronger estrogen response from their own natural estrogen produced by the body,” said Roger Kendall, Ph.D., vice president of research and development at FoodScience of Vermont. “That coupled with some of the natural phytoestrogen compounds that can induce greater estrogen production and utilization can support a woman’s body.”

Researchers at the Karmanos Cancer Institute, Detroit, recently reported I3C and DIM helped downregulate antiapoptotic proteins, inhibiting cell growth and inducing apoptosis of breast cancer cells.³⁷ It was further shown by researchers at the University of California, Berkeley, that DIM has the ability to induce cell cycle arrest by increasing protection of p21.³⁸ As noted in a review from the Eppley Institute for Research in Cancer and Allied Diseases,Omaha, Neb., I3C induces phase I and phase II enzymes that metabolize carcinogens, enhances DNA repair, and induces cell cycle arrest and apoptosis.³⁹ I3C and DIM also affect the metabolism of estrogens, stimulating the production of 2- hydroxy-estradiol, and even protecting the liver against other carcinogens.⁴⁰

Also, the isothiocyanates derived from broccoli and watercress have the ability to suppress the invasive potential of breast cancer cells.⁴¹ Sulforaphane,an isothiocyanate derived from hydrolysis of glucoraphanin, may have particularly strong activity by inducing phase II detoxification enzymes,⁴² and inhibiting chemically-induced mammary tumors in rodents, possibly through mitotic cell cycle arrest.⁴³

Another nutritional compound of interest is inositol hexaphosphate, known as IP6. In vitro work with human breast cancer cells shows IP6 can inhibit cell adhesion, migration and invasion, key steps in metastasis.⁴⁴ It also can decrease cell adhesion,⁴⁵ and modulate cell cycle proteins, decreasing their proliferative effects in breast cancer.⁴⁶ In addition, a study combining IP6 with adriamycin or tamoxifen against three different human breast cancer cell lines found the compound had synergistic benefits.⁴⁷

“On a cellular level, IP6 works by normalizing the elevated rate of cell proliferation and by inducing differentiation, a phenomenon applicable to all cancers,” said AbulKalam Shamsuddin, Ph.D., M.D., a leading researcher on IP6 and the branded ingredient InoCell™. “It appears not to act via hormonal receptors; thus, its anti-cancer action against breast cancer is independent of hormonal status.”

Women are also more likely than men to suffer mood disorders, including depression and anxiety. For example, in a given year, almost 10 percent of the U.S. population suffers a depressive disorder, with nearly twice as many woman afflicted as men, according to the Society for Women’s Health Research.

“Mood disorders have become one of the major medical problems in the United States, and one out of three women are being treated for some mood-related condition due to the stress caused by the increased demands of work and family and the world in which we live,” said Ron Grossman, president of Crania Co.

Studies have shown that the rate of synthesis of serotonin and the level of serotonin in the blood are significantly higher in men than women.^48,49 Because serotonin in the brain is required for mood maintenance, this may help explain the disparity in depression rates. In addition, serotonin, which is calming and sedating, works in complement with dopamine, an energizing neurotransmitter; when levels are unbalanced, mood disorders can develop.

A recent review published in the Journal of the American Medical Women’s Association selected certain integrated treatments for depression, based on the strength of evidence, and detailed not only their impact on depression, but also considerations specific to women, such as use in pregnancy or impact on hormone therapies.⁵⁰ Among the treatments they addressed were folate, Hypericum perforatum, 5-hydroxytryptophan (5-HTP) and omega-3 fatty acids.

“As depression is more common in women than in men, and particularly during the transition time of peri-menopause, it is important to look at alternative remedies,” Hudson said. “For example, the most common manifestation of a folic acid deficiency is depression. And St. John’s wort is an incredibly effective plant for mild to moderate depression, even in comparative studies with antidepressants.”

Regarding folate, the researchers noted the evidence is positive for the B vitamin’s use to augment standard antidepressant treatment, even in women who are not deficient. And folate deficiency may play a role in the etiology of depression, possibly linked to hyperhomocysteinemia.⁵¹ Studies have shown individuals with the lowest levels of homocysteine had the fewest depressive symptoms, while those with the lowest levels of folic acid had increased depressive symptoms.⁵²

The University of Arizona journal also noted St. John’s wort (Hypericum perforatum) has demonstrated efficacy in randomized controlled trials; however, its safety in pregnancy has not been established, and the herb has multiple drug interactions due to its effect on the cytochrome P450 (CYP) 3A pathway.⁵³

In fact, St. John’s wort may prove very beneficial to depressed females. Its efficacy appears comparable to traditional antidepressant drugs in cases of mild to moderate depression.^54,55 It may even have benefits to mood disorders linked to female hormone imbalance. In a double blind, randomized, placebo-controlled trial, 125 women with premenstrual syndrome took 600 mg/d of St. John’s wort or a placebo for two menstrual cycles; intervention appeared to help alleviate the anxietyrelated subgroup of PMS symptoms.⁵⁶

Another botanical with positive mood effects is Apocynum venetum. A specialty extract of Apocynum venetum (as Posinol™, from OptiPure®) had a comparable effect to the pharmaceutical antidepressant imipramine in an animal model of depression,⁵⁷ and appears to work not through the serotonin pathway, but impacts dopamine levels.⁵⁸ In addition, Apocynum extract does not impact CYP3A activity.⁵⁹

A combination of fresh hawthorn (Crataegus oxyacantha) flowers and terminal leaves may help to alleviate menopausal depression, according to Daniel Gagnon, medicinal herbalist and owner of Herbs Etc. Inc. “Hormonal shifts seem to be a major contributor to menopausal depression,” he noted, adding classic French herbal texts reference the ability of this herbal combination to alleviate menopausal depression. “I added fresh hawthorn flowers and terminal leaves to our Menopautonic™ formula, and women reported the felt a noticeable emotional lift.”

5-HTP was also found to have positive efficacy, as demonstrated in clinical trials, though its safety in pregnancy and breastfeeding has not been established.⁶⁰ A Cochrane Database review on 5-HTP’s efficacy in depression found only two trials, involving a total of 64 patients, of sufficient quality to meet inclusion criteria; while the results of the studies found 5-HTP was better than placebo at alleviating depression, more clinical studies are needed to evaluate the substance’s efficacy and safety.⁶¹

Crania Co. developed a slow-dissolving lozenge containing 5-HTP, called CraniYums, designed to bypass the digestive system through sublingual absorption. The company supported a placebo-controlled study, conducted by Cheryle Hart, M.D., which found the use of CraniYums improved mood and decreased irritability in 78 percent of participants. Hart noted it is important to increase levels of serotonin and dopamine in a balanced way. “Excess serotonin can make you feel groggy, while too much dopamine can interfere with sleep,” she said. “By increasing levels of both in a balanced way, CraniYums has been shown over a few weeks to dramatically improve almost all of the classic signs of deficiency.”

One critical basic nutritional compound with benefits in mood support is the omega-3 polyunsaturated fatty acids (PUFAs). Studies suggest there is a causal relationship between omega-3s and depression, with higher long-term consumption of omega-3s associated with lower incidence of depression.⁶² The omega-3 eicosapentaenoic acid (EPA) may be particularly efficacious in this area, working synergistically with standard antidepressant therapies to improve response.⁶³

“Research has linked consumption of essential omega-3 fats to anti-depressive effects,” Trautman said. “A number of population studies show a correlation between diets rich in fish consumption and lower rates of depression, which is not surprising considering no other organ in the body requires as many EFAs as the brain. The evidence is so strong that pharmaceutical companies are starting to use EFAs in the development of antidepressant drugs.”

Of particular interest for women’s health have been recent studies examining whether omega-3 PUFAs can impact postpartum depression. In a cohort of 380 women at six months postpartum, Australian researchers found a 1-percent increase in plasma docosahexaenoic acid (DHA) was associated with a 59-percent reduction in reporting of depressive symptoms.⁶⁴ Similar results were found in a Dutch study examining plasma DHA status among women with and without postpartum depression; they found the postpartum increase of functional DHA status was lower in the “possibly depressed” group than the non-depressed group, leading the researchers to suggest increased DHA during pregnancy and after delivery may be prudent.⁶⁵

Retailers can help their consumers get interested in health issues. “Consumers have the responsibility to look into key health issues, and retailers can help by providing scientific articles and references that support their endeavor,” Kendall said. “These women will find that putting this into practice takes diligence and hard work, but the rewards are worth it. If they apply the principles of health, they will have longer, more productive lives with less degeneration.”

Queen Cuisine

Strong Enough for a Man, Nutritionally Balanced for a Woman

by Steve Myers

The matriarch of not only the typical modern family but also of the natural products market, the healthy woman is the shopper companies have long targeted. However, only recently has there been an influx of female-specific food products hitting the shelves at the local health food store. From cereals to nutrition bars, teas to wine, foods are addressing women's health needs by featuring ingredients linked to various health issues common to the fairer sex.

Women may poetically be sugar and spice and everything nice, but, in reality, they are breasts and bones and everything hormones. Their health is tested and threatened by cancer, osteoporosis, autoimmune diseases, depression and various challenging states of menopause. There is a loyal family of natural products eager to help women ward off unhealthy developments, but these remedies have historically been available primarily in supplement form. Enter functional products, foods and beverages enhanced with vitamins, minerals and specialty ingredients shown to significantly impact general health or specific health problems.

Consider the case of folic acid, in which fortified foods can help correct deficiency, a more common condition in young women than most people realize. A B vitamin, folate helps prevent birth defects, a benefit that should shoot it to the top of the nutrient list for most women anywhere near child-bearing age. However, a recent Gallup Poll commissioned by the March of Dimes revealed only 29 percent of women are taking a daily multi-vitamin containing folic acid, and a mere 19 percent know that the B vitamin prevents birth defects. If it weren't enough that this vitamin helps produce healthier babies, there is evidence it can help impede heart disease and cancer development--two top killers of women.

Another vitamin crucial to women is vitamin D, which is needed in tandem with calcium for healthy bones. The National Institutes of Health (NIH) has reported 68 percent of 44 million Americans at risk of or afflicted with osteoporosis are women, and costs related to the bone-depleting disease exceed $14 billion annually. Calcium and vitamin D are the front line defense against osteoporosis.

Also considered useful in osteoporosis management is soy. From whole food to supplement to functional food ingredient, soy has taken many forms in its quest to improve the bone mineral parameters that mark osteoporosis development and progression. The phytoestrogenic isoflavones in soy also have implications in breast cancer, heart health and various discomforting symptoms of menopause, including hot flushes.

That soy has such broad benefits for women is a trend among other women's health nutrients, such as folate, calcium and carotenoids, which all show activity for heart health and against breast cancer, as do essential fatty acids (EFAs) and phytochemicals abundant in herbal remedies, including flavonoid-rich tea.

Soy is also a good source of lean, heart healthy protein, which is important especially to active women concerned about energy and muscle strength. Power Bar's Pria<\#168> line of nutrition bars for women feature soy as a source of protein. "Pria targets active women who need a convenient but nutritious meal option in their busy, energy-depleting lives," said Andrew Hill, marketing manager for Pria brands. "Our bars feature 23 essential vitamins and minerals as well as antioxidants and soy protein." He added the bars also contain a hefty amount of calcium--from 30 percent to 40 percent of recommended daily allowance (RDA)--in addition to vitamin D and inulin, a type of fiber that aids calcium absorption.

LUNA nutrition bars, a Clif Bar line, include many of these same nutrients women need for overall health and wellness including calcium, folic acid, iron, and antioxidants vitamin A, C and E. "LUNA Sunrise, our newest morning nutrition bar, provides a good source of protein, whole grains and omega-3s," noted Kristel Cerna, LUNA brand director for Clif Bar Inc.. "LUNA Sunrise also contains vitamin D, which helps the body absorb calcium, and is high in fiber, with each bar containing 5 grams." LUNA bars also contain soybeans and oats as a source of both fiber and protein.

Soy is a common ingredient in foods designed for women. Wonder Bar, a candy bar in Ecco Bella's Health by Chocolate line of functional cocoa goodies, features soy in addition to chasteberry and rose oil. "The nutrients and healing herbs help women feel more balanced," said Adrienne Kramer, general manager with Ecco Bella, who noted the rose provides a waft of femininity. "Women report the bars make them feel soothed and relaxed." The line's newest addition, Beautiful Bones Bar, contains calcium and vitamins D and K; its Instant Bliss Beauty Bar (also available as a drink mix) delivers EFAs from cranberry seed oil and a variety of carotenoids for healthy skin.

Zoe Foods makes cereals and bars that also contain EFAs as well as soy. "Soy is a lean and complete source of protein," explained Tori Stuart, president and founder of Zoe. "And we use ground flaxseed, which provides fiber and heart healthy omega-3s."

Despite its prevalence in the women's products market, soy's popularity has dissipated a little, according to Maria Emmer-Aanes, director of marketing for Nature's Path, which makes cereals, granolas and bars targeting women. "Soy is still important, but it is prized mostly by the older demographic," she said. "Our flax has been a big winner with women, as has anything whole grain." She added alternative grains have been especially sought by women, who have taken interest recently in amaranth and quinoa. "This is great for us, because we've been experts at these grain ingredients for a long time," she exclaimed.

While other companies target active, busy women of various ages, some manufacturers have focused on new and expectant mothers. Scott and Beth Vincent, founders of Vincent Foods, noted their Oh Mama! bars contain many ingredients designed to improve the health of a developing fetus. "Probably the most important ingredient is DHA (docosahexaenoic acid), the omega-3 acid crucial for a baby's cognitive and central nervous system development," the Vincents said. "But women are generally not getting enough of this nutrient during pregnancy, as they avoid fish--the main source of DHA in our diets, and most prenatal vitamins do not contain DHA." The duo added DHA may even help with postpartum depression (a correlation has been established but not causality). Other important nutrients in the bar include iron, folate, calcium, magnesium and iodine. 

Similarly, Mommy Munchies nutrition bars, manufactured by Eating for Two Inc., were designed specifically to meet the needs of pregnant and nursing women. Founder Tammy Krutchik reported these bars have the same vitamin and mineral content as prenatal multis, and feature calcium, iron, folic acid, magnesium and selenium. They also contain both soy and whey proteins, as well as a healthy dose of fiber.

Eye on Health and Lifestyle

The wealth of ingredients that add functional benefits for women's health are only part of the formula. In designing bars, drinks and other foodstuffs for the modern women, manufacturers also consider their goals and daily meal needs.

For instance, Emmer-Aanes reported Nature's Path decided to put its granola into bar form because 60 percent of women eat their breakfast in the car. "I would say we are acknowledging the modern female lifestyle more this year than before," she said. "I'm a mom of two kids, so I come in with a perspective very much tuned into women's needs." She further noted the company's Optimum brand products target the single active women who are time-starved and juggling diet goals and overall health.

Stuart agreed. "We have received hundreds of e-mails from busy women over the years," she said. "They struggle to juggle all of the demands in their life ranging from family to work. These women tell us that Zoe Foods provides them with products that they not only enjoy eating, but that they also feel good about because they know it's good for them." She added women also like the fact that Zoe cereals and bars can be enjoyed by their whole family, even if the woman is using the products as part of a weight management program.

As is the case elsewhere in the retail food industry, convenience is king …err queen ... when it comes to female-specific foods. Hill said Pria bars are ideal for a quick meal at the start of or any time throughout a busy day. Pria provides convenience and health for women in three different types of bars--110 Plus is low calorie; Carb select has only 1 g sugar and 2 g impact carbs; and Complete Nutrition has a full range of women's health ingredients while keeping calories and carbs reasonably low.

The nutrition seems an ideal fit for the active, busy woman. "With LUNA nutrition bars, women have a nutritious, healthy, portable option that women can appreciate while not feeling guilty that they are consuming artificial ingredients or empty calories," Cerna said, adding 25 percent of LUNA's ingredients are certified organic.

Low calorie was also a factor in creating White Lie Early Season Chardonnay, a wine made by women for women. "There definitely is a market demand by women for low-alcohol, low calorie wine, and White Lie filled this need," stated Rebecca Fine, public relations director for Foster's Wines. "We choose Chardonnay, because it can be grown and picked for low sugar content." Picking the grapes early in the season results in less brix, or sugar content, which results in less alcohol content. "Women were giving up wine during the week because of the calories and the high alcohol content," she said. Women are huge purchasers of wine, but they have been are largely ignored by wine makers. This is changing with the introduction last year of White Lie, as well as the emergence of other wines designed for women, including Seduction from O'Brien Family Vineyards and Mad Housewife from Rainier Wines. Wine has a desirable relaxing effect and is also a great vehicle for healthy polyphenols that combat heart disease and cancer.

For Ecco Bella and other companies, chocolate is not only an ideal platform for many women's health ingredients, but it also delivers healthy antioxidants and enjoys a great mood-enhancing reputation. "Our bars are designed for casual consumption whenever a woman wants to relax and indulge," Kramer said. "Chocolate is a great medium for certain nutrients, including calcium and carotenoids for skin."

Time is definitely a concern for expectant mothers. "However, one of the most important things to understand about Oh Mama! bars is that they were designed with the woman in mind who is taking a prenatal vitamin but doesn't have time to cook the perfect pregnancy dinner each evening," the Vincents explained. "She needs help filling in the nutritional 'holes' that a prenatal vitamin can't--at the same time she doesn't need to be over-supplemented with certain fat-soluble vitamins which can cause trouble. It's a fairly specific vitamin mix."

As in tune as women are to their health and that of their families, social and environmental issues are also important to this consumer demographic. "Although we offer foods that help with physical health, we also have a lot of emotional connection to our brand with women, in that we are conscientious company that gives back to planet and environment," Emmer-Aanes said. "We try to leave the lightest footprint on the earth that we can." To this end, Nature's Path uses sustainable packaging, which uses less energy, less water and saves 76 tons of cardboard. It also donates 1 percent of profits from its EnviroKidz cereals to help conserve habitats for endangered species, in addition to working with the American Dietetic Association and sponsoring women's events.

Partnerships with key women's health organizations and sponsorships of women's health and athletic events are good ways to reach female consumers interested in natural health.

"In addition to providing women the right nutrition for their body LUNA also supports women as they take care of their community and environment," Cerna said, noting the company supports initiatives such as LUNAFEST and the LUNA Chix teams. "Both of these community programs help bring women together to support one another and to raise money for the Breast Cancer Fund."

As it falls under the Power Bar umbrella, Pria benefits from the connections and presence of its parent company at various events, including major professional and amateur athletic competitions. However, Hill stated Pria engages women's health specifically by sponsoring Race for the Cure breast cancer events in 14 locations nationwide, in addition to partnerships with organizations such as Illumineri, Discovery Health and Baby Boot Camp. He also emphasized the importance of supporting women's health education. Pria maintains an educational library on its Web site and sends female customers information via e-mail. "Our Weekly Sparks offer inspirational and health tips, nutrition articles and specials," he said.

Ringing the education bell, Zoe Foods donates thousands of product samples annually for nutrition education. "We work with registered dietitians and different health care organizations to help women and their families learn how to eat nutritious foods that are convenient and taste great," Stuart said. "Additionally, Zoe Foods worked with a registered dietitian to create the Zoe Foods Healthy Meal Plan to get families started on well balanced, nutritious meals."

Education is a must for products targeting pregnant women. "Oh Mama! requires careful education," the Vincents confirmed. "Women and their doctors have questions about Oh Mama!, and we try to address many of these questions in our consumer education sheets and on our Web site."

Women have always taken care of their families, but as women take center stage in the stories of their own health and lives, they are demanding more convenient foods that contain nutrients and specialty ingredients tailored to the health concerns central to women's health. Food manufacturers have taken notice of the breadth of health benefits these nutrients offer women and have increased their efforts to provide female consumers with more options to consuming these nutrients in foods fit for a queen.

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