It’s a Woman’s World

From the teens to the twilight years, women experience numerous biological and social changes that affect their health, including menses, pregnancy, menopause and post-menopause. These life stages are unique to the female gender; however, many health problems that confront them, such as heart disease, depression and cognitive decline, also haunt men. While physical differences between men and women are evident, there are also social differences, such as women’s tendency to run the household, including overseeing the family’s health and diet. In fact, women are responsible for almost all household spending decisions and consumer purchases (U.S. Census Bureau), and it’s no surprise they dominate natural products consumerism. Likewise, natural products retailers have a long list of inventory options for stocking products designed specifically for various stages and aspects of women’s health.

Basic Nutrition

Whether in her childbearing years or beyond, a woman can benefit greatly from ensuring adequate intake of some basic vitamins and minerals. Calcium is one of the most popular nutrients in the women’s health market, due to its positive effects on bone mineral density (BMD) and osteoporosis risk. Absorption of calcium requires vitamin D, and the two are commonly paired for improved bone health. Sufficient vitamin D intake is also linked to reduced risk of premenstrual syndrome (PMS), while deficiency has been linked to incidence bacterial vaginosis.^1,2

Often overlooked, magnesium also helps with calcium absorption and regulation, factoring in many health situations such as heart heath, mood, stress, osteoporosis, pregnancy, headache, diabetes and chronic fatigue.

“Our calcium-magnesium product Osteo Calm was developed for bone health specifically for women,” said Ken Whitman, president of Peter Gillham's Natural Vitality, whose Natural Calm magnesium product has some female-specific applications including PMS and pregnancy. In fact, magnesium has also partnered with vitamin B6 to tame PMS symptoms such as mood swings and irritability.³

Women’s multivitamins tend to focus on bones, skin, hair, breast and reproductive health, and such formulations tend to feature calcium, vitamin D and iron. Iron deficiency anemia affects one in four women of reproductive age and causes problems with memory, fatigue and concentration. Iron also helps metabolize B vitamins, including folic acid, which is very important to women of childbearing age in preventing birth defects.

These minerals are commonly featured in women’s multis; however, many experts caution prenatal vitamins often contain higher amounts of iron than is healthy for older women, age 50 and up. Too much iron can increase the risk of diabetes and harm the liver. Thus, it is important that older women and those not pregnant avoid prenatal formulations. Prenatal multis also contain amounts of folate that are about twice the level recommended for non-pregnant women; too much folate can promote the growth of cancer cells. Still, prenatal vitamins are very important to expecting mothers. A University of North Carolina, Chapel Hill, study found risk for miscarriage was 57 percent lower among women who took vitamins, compared to those who did not.⁴

More commonly promoted for heart health, vitamin E also has benefits for women dealing with dysmenorrhea, a complication of menses that can include pain and blood loss. In one trial, girls aged 15 to 17 who took 400 IU/d vitamin E for two and four months experienced less blood loss and decreased severity of pain associated with their primary dysmenorrhea.⁵

Dysmenorrhea has been further linked to the body’s balance of omega-3 and omega-6 essential fatty acids (EFAs). While the ideal ratio for improving menstrual symptoms favors increased intake of anti-inflammatory omega-3s, there is one omega-6—gamma linolenic acid (GLA) found in borage and evening primrose oils—that can help address PMS-associated symptoms such as breast, joint and muscle tenderness.⁶ On the other hand, intake of the omega-3 docosahexaenoic acid (DHA) by expectant mothers correlates to infant brain development, and may help address postpartum depression.^7,8

About 192,370 new cases of breast cancer will be diagnosed in American women in 2009, according to the American Cancer Society. Breast cancer most often starts in the mammary ducts and grows slowly—by the time the cancerous lump is detectable by touch, the tumor could be ten years old, although some tumors can grow more rapidly. Invasive breast cancer spreads from the ducts or lobules into the surrounding breast tissue, at which point it can spread much more easily and quickly to lymph nodes and nearby organs.

Some women’s health staples such as folate, calcium and soy have been shown at higher intake levels to decrease the risk of breast cancer development. Managing cancer risk and care naturally involves numerous plant compounds, including flavonoids, carotenoids and lignans.

The rich pigments found in plants and crustaceans, carotenoids have generated mixed results in breast cancer trials. However, an analysis of data from the Nurse’s Health Study showed vitamin A and various carotenoids specifically reduce breast cancer risk in women who smoke regularly.⁹ Beta-carotene, a provitamin A carotenoid, has been found to down regulate a number of MCF-7 breast cancer cells and increase apoptosis.¹⁰

Certain compounds in mushrooms may also hold potential as anti-cancer agents. Daniel Sliva, Ph.D., of Indiana University and the Cancer Research Laboratory of Methodist Research Institute, Indianapolis, discovered an extract of a new mushroom (Phellinus linteus) called Meshima in Japan—literally meaning Women’s Island—suppresses invasive behaviors of abnormal breast cells more significantly than several other mushroom extracts. Sliva collaborated with Maitake Products to develop BreastMate™, a Meshima supplement that also contains synergistic ingredients such as Maitake SX-Fraction®, broccoli extract, green tea extract, vitamin D3 and folic acid. In his study of this supplement, Sliva found it inhibits proliferation and colony formation of highly invasive human breast cancer cells MDA-MB-231, in addition to curtailing cell adhesion and angiogenesis.¹¹

Two compounds found in cruciferous vegetables such as broccoli are also promising anti-cancer supplements. Sulforaphane, an isothiocyanate, has garnered attention for possibly impacting phase II detoxification enzymes and inhibiting chemically induced mammary tumors, although the research is mostly in animals.¹² DIM(diindolylmethane), a metabolite of indole-3-carbinole (I3C), may decrease breast cancer risk by breaking down estrogen into less carcinogenic or non-carcinogenic metabolites.¹³

Some cancer cells in breasts have estrogen receptors and are controlled by estrogen. These types of cancer cells can respond to phystoestrogens such as lignans. French researchers reported high dietary intakes of plant lignans were associated with reduced risks of estrogen- and progesterone-positive breast cancer in postmenopausal, but not in premenopausal women.¹⁴

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For menopausal women, the good news is two compounds lauded for hormonal improvements of menopause symptoms are also good for breast health.

Women and wine are a dynamic duo. Resveratrol, a flavonoid found in grapes and wine, can inhibit breast cancer cell proliferation and induce apoptosis.¹⁵ Lab work has suggested resveratrol and its derivatives target inflammation, angiogenesis and metastasis.¹⁶

“Resveratrol is considered a phytohormone,” said Michael Hill, marketing and communications for Reserveage Organics, noting the flavonoid has a positive estrogen effect by binding to estrogen receptors in the body. “Some of the research that has been completed to date has looked at the in vitro effects of estrogen… demonstrating positive outcomes for menopausal women by balancing the role of estrogen within the body.”

Hill reported several in vitro and animal studies have shown some positive outcomes when examining the effects of resveratrol on bone loss, suggesting it is a good alternative to hormone replacement therapy (HRT) and associated side effects. “It has been suggested that because of the estrogen effect resveratrol can decrease hot flashes, emotional imbalance, bone loss and improve skin tone and cardiac health (the number one cause of death in women),” Hill said. “This research still needs to be verified in human clinical trials, but is showing significant outcomes in vitro and in animal studies.”

Similarly, black cohosh extract has been shown in animal trials to contribute to cancer-cell death. Funded by the National Institutes of Health (NIH) and the Susan G. Komen Breast Cancer Foundation, researchers from Columbia University, New York, and Jinan University, China, found black cohosh extract purified to triterpene glycoside content (supplied by Naturex) inhibited growth of the human breast cancer cell line MDAMB-453.¹⁷ However, black cohosh may interfere with a couple of chemotherapy drugs, increasing their cytotoxicity, so retailers should emphasize the need for customers to consult with their health care provider if taking black cohosh during chemo treatment.

This is new territory for black cohosh, which has long been a favorite of women seeking relief from hot flashes and other menopausal symptoms. University of Illinois, Chicago, (UIC) has an NIH research center focused on botanicals and women’s health, where research has demonstrated black cohosh can alleviate hot flashes, profuse sweating, insomnia and anxiety—without estrogenic actions.¹⁸ However, the most recent study on black cohosh and menopause offered more subdued results that many saw as negative.¹⁹ UIC researchers compared black cohosh and red clover to HRT and placebo, finding no significant differences in hot flash reduction amongst the various treatment groups, including the botanicals.

However, Tori Hudson, N.D., noted the black cohosh product used is not the same standardized extract preparation used in the most effective of those 100 plus studies, and there was very small number of women studied in each treatment arm—about 20. “Some very positive findings of this study of note would probably be of interest to women in the area of safety: In the two botanical groups, the black cohosh and the red clover preparations, there was no evidence for liver toxicity for black cohosh and no adverse effect on blood coagulation for the red clover group,” she added. “Both botanical treatments met the measured safety parameters for breast and uterine safety, liver enzymes, lipid profiles and blood counts. In the estrogen/progestin group, several women reported abnormal bleeding. Lastly, the black cohosh and red clover group did not worsen memory, while the hormone therapy did cause a slight negative effect on memory.”

In fact, Hudson, a physician in clinical practice, said the recent UIC study will not discourage her from using black cohosh as her primary choice for the relief of hot flashes and night sweats in perimenopausal and menopausal women. “There have been over 100 clinical studies on black cohosh, with the majority showing clinical effects, especially of the most common researched extract, known as REMIFEMIN (from Enzymatic Therapy),” she said.

Paula Hanek, brand manager for Remifemin, noted the product has been popular in Europe for 50 years and has been the subject of 15 clinical studies and 90 scientific papers. “Remifemin provides a 70 percent reduction in menopausal symptoms,” she said. “Completely hormone-free, it can be used safely by women who have had breast cancer and cannot take estrogen.”

A 2007 national survey of 1,258 women aged 40 to 55 revealed more than one-third of women have tried natural supplements to relieve menopausal symptoms, with one-quarter saying dietary supplements are their treatment of choice. In the poll from ADM World, a majority of women said they would like their health care professional to share more information with them about non-pharmaceutical methods for addressing menopausal symptoms and be open to discussions about natural treatments.

Unlike black cohosh, red clover and soy are sought after by menopausal women for their phytoestrogen isoflavones. Soy isoflavones have undergone extensive study, showing a tendency to reduce hot flashes by 50 to 60 percent, and decrease night sweats by 40 to 50 percent.^20,21 Both individual isoflavones daidzein and genistein have demonstrated these menopausal benefits on their own.^22,23

Soy’s journey in the women’s health menopause market has not been without its bumps. Some negative reviews in 2007 concluded soy and its isoflavones do not reduce hot flashes.^24,25 However, a late 2008 review from the University of Minnesota reported consumption of 30 mg/d of soy isoflavones (or at least 15 mg of genistein) reduced hot flashes by up to 50 percent.²⁶ And a 2009 Johns Hopkins University, Baltimore, trial reported supplementation with soy (as Revival Soy, from Physicians Laboratories) can reduce hot flashes and night sweats, while improving quality of life in menopausal women.²⁷ Adding to the recent soy resurrection, a new study first presented at the Experimental Biology 2009 meeting in New Orleans revealed a form of pure genistein reduced the number and duration of hot flashes in peri- and postmenopausal women.

Compounding its benefits to women’s health, soy delivers not only its well-known heart health benefits, but it also offers positive effects on bone health. According to the Shanghai Women’s Health Study, women with the highest soy intakes are 37-percent less likely to experience a bone fracture than are women with the lowest soy intakes.²⁸ Similarly, one study found 24 months of daily genistein supplement increased BMD, while those taking placebo showed decreased BMD.²⁹ Just as with soy and hot flashes, a recent study out of University of Connecticut Health Center, Farmington, found neither soy protein nor isoflavone supplements had a positive effect on BMD in women older than 60.³⁰

Red clover and its isoflavones have also faced both praise and scrutiny from researchers. Early research found as much as a 44-percent decrease in hot flashes in women taking 80 mg/d of isoflavones (as Promensil, from Novogen).³¹ Subsequent research even discovered red clover isoflavone supplementation not only decreased menopause symptoms, but also reduced vaginal cytology and triglyceride levels.³² But, a 2003 University of California, San Francisco, study reported 12 weeks of intervention with either Promensil (82 mg/d of total isoflavones) or Rimostil (57 mg/d of total isoflavones) produced a mere 5-percent reduction in hot flashes, not much better than placebo.³³

As with soy, women can get multiple benefits from red clover in the area of heart health. Intake of red clover isoflavones has been linked with decreased risk of cardiovascular disease (CVD), including reduction of cholesterol.^34,35 Australian scientists recently reported their experiments shed light on how red clover can lower the risk of heart disease, noting red clover isoflavones enriched with formononetin (the precursor to daidzein) reduced arterial stiffness and total vascular resistance.³⁶ Red clover also mirrors soy in benefiting bone health. Research shows supplementation with red clover isoflavones can positively impact BMD and slow bone loss in estrogen-related osteoporosis.^37,38

An interesting botanical known more for its purported sexual health benefits for men, Peruvian maca can help women address hormonal issues, including PMS, menstruation and menopause. Women at each stage of life experience different health and hormonal issues, explained James Frame, Natural Health International, which makes Femmenessence, a line of products that features a proprietary combination of 13 different phenotypes or subspecies of the adaptogenic herb Maca (Lepidium peruvianum), trademarked Maca-Go.

“The 13 different phenotypes in maca sometimes elicit different physiological effects on the body and, thus, we have found particular phenotypes that do specific things important for women at different stages,” Frame said. “[For example] cholesterol is far more of an issue for postmenopausal women than younger women, while fertility is more important for a young woman than post menopause.” He further noted Femmenessence supports the hypothalamus pituitary adrenal axis, in turn stimulating the body’s own hormone production; it does not introduce hormones into the body that can potentially affect the liver or kidneys.

The science on maca on such hormonal issues is building. A 2006 research report concluded, “In addition to reduction in body weight, blood pressure and increasing serum HDL and iron, pre-gelatinized Maca-GO may be a valuable non-hormonal plant preparation for balancing levels of hormones (FSH, E2, PG and ACTH) and alleviating negative physiological and psychological symptoms (frequency of hot flushes, incidence in night sweating, interrupted sleep pattern, nervousness, depression and heart palpitations) experienced by women in perimenopausal stage.”³⁹ Similar results were found in early postmenopausal women.⁴⁰

“Not only can we show the effects on hormone levels but, as our clinical trials show, we can demonstrate the health benefits people would expect to see from improving their hormone levels,” Frame said. Among these expected hormonal results, he noted, are: increases in bone density, increases in high-density lipoprotein cholesterol (HDL), reductions in low-density lipoprotein (LDL) and body weight in postmenopausal women; women having amazing results with treating polycycstic ovary syndrome (PCOS) and amenorrhea; an 84-percent success rate in reducing menopausal symptoms, compared to the normal success rate with black cohosh, red clover or soy (around 60 percent); and improvements in fertility in couples trying to conceive.

A new Greek-Arabic botanical formula, may also help women optimizetheir sexual health. A proprietary combination of Asafoetida root extract (5:1, 46 mg) and Capparis spinosa extract (6:1, 95 mg), Sprunk-Jansen’s Feminine™ supplement, was designed to support healthy libido and energy.

An observational study of 60 healthy females demonstrated Feminine significantly improved female sexual performance within six months of starting the once-a-day supplementation. “One group of 32 young and married women was selected on the basis of having difficulties with sexual activity with their husbands,” explained Ulrik Breval-Carlsson, president of Sprunk-Jansen. “The second group of 28 women was selected on the basis of infertility.” In the first group, 27 women (84 percent) reported significant improvements of their sexual difficulties and improved libido. In the second group, 21 women (75 percent) reported that their libido was improved within one month.

Another natural sexual health aid is ArginMax® for Women (Daily Wellness Co.), a combination of L-arginine, Panax ginseng, Ginkgo biloba, damiana leaf, and various vitamins and minerals. According to the company, calcium and iron help relieve fatigue; damania calms anxiety; and arginine, ginkgo and ginseng work together to promote improved circulation, which is critical to female arousal, engorgement and lubrication.

In 2009, research presented at the 19th World Congress for Sexual Health in Goteborg, Sweden, outlined how ArginMax supplementation improved sexual desire and overall satisfaction in women of differing menopausal status. In the study, 108 women—ages 22 to 73 and lacking in sexual desire—received either ArginMax or placebo; they were evaluated using the Female Sexual Function Index (FSFI) sexual health before starting and after completing the four-week long study. In the end, 72 percent of the premenopausal women experienced increased levels of sexual desire, while 68 percent reported increased satisfaction with their overall sex life. Among the perimenopausal women, there was a 79-percent increase in satisfaction with their sexual relationship and a 64-percent improvement in vaginal dryness and degree of clitoral sensation. Also, 86 percent of perimenopausal subjects reported improvement in frequency of intercourse; and 56 of post-menopausal subjects had increased sexual desire, compared to only 8 percent in the placebo group.

An important part of the health of women of all ages, sexual health is not always a countertop market segment. “Frankly, some independent retailers are still uncomfortable with sexual health issues and selling products that address those issues,” Frame said, noting it is a retailer’s choice to sell what they are comfortable with. “With each year, society becomes much more comfortable about the expression of sexuality. It is healthy and it is obviously a natural human experience.” That said, Frame noted there is a wide line separating dignified packaging and marketing from the crass or colorful. “Retailers that sell natural sexual support supplements need to select primarily based on who their clientele is, not what they themselves would use.”

The scope of women’s health is wide, and the growing list of natural products that help address the health concerns that surface in the various stages of a woman’s life are just as plentiful. The key for retailers is to know the products and any associated research, and present the right information and products to women depending on their specific age and needs.

Sure, chocolate contains a compound that can mimic orgasm, and that kind of happiness surely does wonders for a woman’s wellness; however, antioxidant flavonoids in chocolate are the stars of recent results from research on various women’s health issues.

If women are all heart, then there is no wonder they often crave chocolate. Regular intake of dark chocolate has been linked with positive effects on blood pressure, insulin resistance, and vascular and platelet function. Swiss researchers (who probably have chocolate in their genes) found dark chocolate (40 g, 70 percent cocoa) induced coronary vasodilation, improved coronary vascular function and decreased platelet adhesion (clogging) in heart transplant patients 2 hours after consumption (Circulation. 2007;116(21):2360-2). University of Illinois researchers showed eating two bars (22 g total) of flavanol-rich CocoaVia, from Mars Co., a day not only lowered cholesterol, but also lowered systolic blood pressure (J Nutr. 2008 Apr;138(4):725-31). They theorized the cholesterol reduction was due to plant sterols infused in the bars, while the blood pressure benefits were due to the natural flavanols content. Ever the chocolate cardiologists, the Swiss produced additional research showing adding flavanol-rich chocolate to the diet reversed vascular dysfunction in diabetes patients (J Am Coll Cardiol. 2008;51(22):2150-2).

Many pregnant women wonder if consuming chocolate is good or bad during pregnancy. New research suggests consuming chocolate during pregnancy may lower the risk of preeclampsia (Epidemiol. 2008;19(3):459-64).

And while women typically experience chocolate cravings just at the onset of their period, new research is looking into the effect of dark chocolate on PMS symptoms. They already know chocolate can help improve mood and stress problems, and data is now revealing flavonoids in cocoa may protect the brain from oxidative stress, improving cognitive function.

What other reasons do women need to make their chocolate consumption more regular?

Candid Talk on Yeast Infection

When the Candida fungi, most commonly Candida albicans, infect a woman, she seeks immediate relief from the ensuing candidasis, also called a yeast infection. Part of what sets the stage for candida infection is an imbalance of friendly bacteria. There is a homeopathic product that can help bring relief.

Candid-Free, from Vaxa International, uses friendly bacteria, phytomedicinals, natural antibiotics and other nutrients to bring down the numbers of candida bacteria, boost the immune system to fight the infection and relieve symptoms such as itching and burning. A few of the key homeopathic ingredients include Candida Albicans Nosode, Kreosotum and Pulsatilla Nigricans. Nancy Hotl, director of Marketing for Vaxa, said Candid-Free can be used either in cases of active infections or as a preventative measure.

Other homeopathics in Vaxa’s women’s health line include formulations for stress, anxiety, fatigue, attention, focus, concentration and depression.

Natural products for women still dealing with menstruation do not stop at dietary supplements. Among the many offerings of natural, organic and eco-friendly tampons and pads is the Diva Cup, a menstrual cup with a diminished eco footprint. Diva cup contains no latex, plastic or BPA; it is reusable and can be worn for up to 12 hours at a time, saving women between $150 and $200 per year, compared to tampons and pads. “Billions of tons of tampons and pads are dumped into the environment every year and more women worldwide are realizing that they do not have to be part of this type of pollution,” said Susan Carskadon, Diva International, who added the Diva Cup is biodegradable and does not leach additives, surfactants, glues and other toxins, as do conventional tampons and pads. She noted natural products retailers embraced the product when it was launched six years ago and remain the product’s most significant distribution channel. “[We] support independent natural products retailers with consumer fliers and a demo model that allows women to feel the softness of the cup at point-of-purchase.”