Meeting Women’s Changing Nutritional Needs

Most attention in women’s health—both mainstream and alternative care—focuses on hormone-related conditions. This is likely due to the fact that women face fluctuating levels of the major female sexual hormones throughout their lives. These include estrogen, which is responsible for guiding a woman’s body through pregnancy; progesterone, which works in concert with estrogen on conception and regulates menstruation; luteinizing hormone (LH), which controls release of a follicle from the ovaries; and androgen, which is partially responsible for growth at puberty and which falls off dramatically at menopause.

Bill Sickert, a nutritional industry consultant, noted the interactions of these hormones and related body conditions cause constant changes to a woman’s nutritional needs. “Every month, from her first menstruation to death, there is a very complex messaging system involving hormones and enzymes that dictate ovulation, menstruation, peri-menopause and menopause, as well as all the subsequent processes of hormonal and age-related endocrine changes,” he said.

One basic product for any female natural products shopper is an evidence-based multivitamin. “Multivitamins can help to fill gaps in the diet and provide optimal nutrient potencies to maintain health and vitality in the short term while protecting long-term health,” said Marci Clow, M.S., R.D., product information manager with Rainbow Light. “Then, depending on individual needs, supplements can help with stress management, support metabolism and weight, promote heart health or blood sugar balance.”

These specialty nutrients can augment a good diet. “Women have different nutrient needs than those of men,” said Traci Kirksey, director of sales and marketing with Gematria Products Inc., makers of HERBalance™. “They may need fewer calories but only slightly less protein and the same amount or more of many of the essential nutrients. Most women do best on a low- to moderate-calorie diet that includes a good amount of protein and vegetables, some whole grains with a few fruits and sweet foods.”

It is likely your female shoppers are quite open to specialty formulas to address their individual nutritional needs. Understanding what those needs are for each cycle of life is the first step to fulfill that desire.

If everything is in place in early life, girls will begin menarche around the age of 13, but it can occur between 11 and 18; it is characterized by a rapid increase in height, changes in body shape, growth of body hair and mood changes. “With the changes at menarche, the body’s nutrient requirements reach their peak,” said Valerie Otto, president of Oona Health. “This is contrasted with a strong tendency of young women to ‘diet’ because of body image concerns, thus compromising their food and nutritional intake.”

One of the most critical issues is calcium intake, which is often missed as teenagers cut out “fattening” dairy products. “Getting enough calcium as teenagers can have a profound effect on bone health later in life, but can be difficult if they are lactose intolerant or simply don’t like milk,” said Geri Burdak, nutritionist and director of public affairs for The Solae Co. in St. Louis. She noted calcium-enriched soy milk and other soy products offer a viable alternative. “A high peak bone mass and regular exercise provides a good foundation for when a woman reaches her 50s and beyond.”

Stress conditions can also strike teens, influencing the body’s physiological and psychological wellness. “Adolescent girls tend to become stressed from interpersonal situations, body and self-concept issues easier than boys, and stress is more likely to lead to depression in girls than in boys,” said Vijay Juturu, Ph.D., a nutritional scientist with Nutrition 21, supplier of Chromax® chromium picolinate. Studies with chromium have shown its ability to support blood glucose levels as well as positively influence mood.

Generally, however, the emphasis in these years is good nutrition. “Most women don’t experience major health concerns during their teens through early 30s,” Clow said. “Rather, the focus should be on health maintenance and disease prevention. Peak bone mass is reached between the ages of 25 and 35, and bone mass begins to gradually diminish around age 40. It’s also important to consume enough iron during the menstruating years to prevent irondeficiency anemia.”

While iron supplements are widely used in an attempt to prevent anemia, many inorganic iron supplements such as ferrous sulfate have low bioavailability and typically produce undesirable side effects such as gastric upset and nausea. Instead, consumers may prefer a chelated iron (such as Albion’s patented Ferrochel®), which provides enhanced bioavailability and reduced gastric irritation. Studies have shown iron chelate (as Ferrochel) is effective in treating anemia in women and children, and at lower doses than other forms of iron supplements. A Brazilian study, for example, found 15 mg/d of iron-bis-glycinate chelate (as Ferrochel) was more effective in treating iron deficiency in pregnant women than 40 mg of ferrous sulfate.¹

One option retailers can provide for their customers is female-specific multis, designed to help women overcome hormone changes, environmental toxins and stressful lifestyles. “Taking a ‘woman’s’ nutritional supplement is a brilliant way to make sure a woman is getting the full range of essential vitamins and minerals to meet her special nutritional needs,” said Holly Lucille, N.D., R.N., member of the scientific advisory board for Enzymatic Therapy. “Women also benefit from herbs and nutrients that help relieve symptoms associated with hormone fluctuations.”

Those hormone fluctuations can manifest as premenstrual syndrome (PMS), which has been characterized by more than 150 symptoms, ranging from mood swings to weight gain to acne. It is estimated that PMS symptoms may impact up to 95 percent of women, although they may affect 5 percent of women severely.² While scientists have been unable to identify a single cause of PMS, theories range from hormonal and chemical to psychological and nutritional, though it is likely a combination of genetic, environmental and physiological factors.

Nutrients that may play a role include calcium and the B vitamins. Calcium appears to support cyclic fluctuations during the menstrual cycle, leading some scientists to suggest PMS is a clinical manifestation of calcium deficiency.³ In addition, a systematic review of vitamin B6 in the treatment of PMS suggested up to 100 mg/d would likely benefit PMS symptoms and premenstrual depression.⁴ “B6 is needed for the liver to conjugate estrogen into neurotransmitters that regulate our moods,” Otto said. “Folic acid is of value throughout life.”

She further noted the hormonal theory about PMS occurrence is based on a theory of an imbalance in the estrogen to progesterone ratio, which over-stimulates the target tissues. For example, excess estrogen may cause symptoms such as bloating, breast tenderness and increased cramping, while excess progesterone causes mild depression, decreased libido and fatigue. “Specialty nutrients can do wonders for PMS by supporting and encouraging the body to normalize the production of hormones,” Otto said. “For women who experience the most common types of PMS symptoms, a highquality chaste tree berry with a bit of added black cohosh can do wonders.”

The medicinal use of chaste tree (Vitex agnus-castus) dates back to the 1st century A.D.; its common names—chaste tree and monk’s pepper—stem from the belief that the plant suppresses libido in women and the fact that European monks used the fruit as a cooking spice and libido suppressant. It has been shown efficacious in treating a range of gynecological disorders, including menstrual irregularities, hormone imbalances and cyclic mastalgia. In a double blind, placebo-controlled study in 170 women with PMS who took Vitex or placebo for three consecutive cycles, treatment was shown to significantly improve symptoms such as irritability, headache, breast fullness and bloating.⁵

Another compound from the botanical world with benefits to PMS is French maritime pine bark extract, patented as Pycnogenol®. “For women in their reproductive years, Pycnogenol is particularly interesting for soothing of menstrual discomfort,” said Frank Schonlau, Ph.D., director of research with Horphag Research, suppliers of Pycnogenol. “Pycnogenol contains spasmolytic components, which reduce uteral cramping and the resulting cramping pain.”

Horphag holds a U.S. patent for the use of Pycnogenol in reducing the pain and discomfort associated with menstruation. Speculation on mechanism of action is that antioxidants counter cramps by reducing inflammatory response. A study in 47 patients with menstrual pain found 30 mg orally twice daily lowered the pain scores significantly, and continuation of treatment over a second menstrual cycle further lowered the pain index.⁶

Specialty PMS formulas may also include additional nutrients to address related health concerns. “The ingredients of HERBalance work synergistically to not only reduce problems related to PMS, but also to help balance sugar, salt and other hunger cravings and even boost mood and energy,” Kirksey said. “The amino acids in the product are those used in the brain and body to make the key neurotransmitters that balance appetite and elevate mood and well-being.”

As women head into their 40s, they are facing drops in hormone levels, slowing metabolism and increased levels of stress, which is linked to increasing levels of cortisol. The slowing metabolism often leads to weight gain. “In the late 30s into the 40s, many women are concerned with the health and well-being of their families, but they need to remember not to neglect their own health and well-being,” said Shawn Talbott, Ph.D., the formulator of CortiSlim. “These tend to be the ‘weight gain’ decades for most women, so attention to diet, exercise and proper supplementation is vital.”

Talbott noted increased levels of cortisol often leads women to eat the “wrong” foods and gain weight at an accelerated pace. To combat this, Talbott formulated CortiSlim, which controls cortisol levels, aiding weight loss efforts. In a recent study on CortiSlim, 50 subjects were recruited from among volunteers who had tried and failed to lose weight on other diet programs, or who had lost weight and regained it within the last year.⁷ The subjects consumed two CortiSlim capsules per day or placebo for 12 weeks. Those receiving CortiSlim lost nine times as much weight as the control group and had twice the fat loss and inches lost from the mid-section. In addition, subjects taking CortiSlim had a 15 percent improvement in overall mood and a 20 percent reduction in cortisol levels.

Other companies are also exploring agespecific diet formulas. Cytodyne Technologies, for example, recently debuted Xenadrine 40+, formulated to overcome the metabolic hurdle associated with decreasing lean muscle mass as the body ages. The formula includes a specialty herbal combination, a mushroom complex for immune support, niacin, zinc and Norambrolide™, a fermented Salvia sclarea leaf extract. In surveys of its customers, Cytodyne found 78 percent of users lost weight using the Xenadrine 40+ product, 35 percent had fewer aches and pains and 21 percent had less fatigue.

A more serious health issue in the 40s is the increased risk of breast cancer. It is estimated one in eight women will develop breast cancer during her lifetime, though the risk can be mitigated somewhat by dietary influence. In particular, there have been several studies linking flaxseed and its lignans to breast health.

“Lignans are powerful antioxidants and are also phytoestrogens, which means they can have a balancing effect on natural hormone levels and influence sex hormone production, metabolism and biological activities,” said Jocelyn Mathern, R.D., technical specialist with Acatris, supplier of LinumLife flax lignans. “They support breast health, cardiovascular health and bone health and reduce menopause symptoms. They favorably influence estrogen metabolism by improving the ratio of estrogen metabolites to a more protective profile.”

Human studies have investigated flaxseed’s biological effects on breast cancer. In one study of patients newly diagnosed with breast cancer who received a muffin with 25 g of flaxseed or a control muffin, the flaxseed and its lignans reduced tumor growth comparable to the effects seen with preoperative Tamoxifen.⁸ Another study in 116 premenopausal women with severe cyclical mastalgia (a disorder associated with breast cancer risk) who received a muffin with 25 g of flaxseed or a control muffin found flaxseed was found effective in relieving symptoms including breast pain in the treatment group.⁹

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 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.¹⁰ 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.¹¹

Phytoestrogens are also first line nutraceuticals against the onset of menopausal symptoms. Menopause is defined by the North American Menopause Society (NAMS) as the point after 12 months of absence of menstruation when there is a near absence of ovarian hormone secretion.

The average age a woman reaches menopause in the Western world is 51.4 years, although the age may range between 40 and 58. Although life expectancy has increased over the past few decades, the age of menopause has not changed during the past few centuries, according to NAMS, and is unaffected by improvements in nutrition and a reduction in disease.

“Ask most women entering perimenopause or menopause, and the response will be that it is not a smooth transition,” Otto said. “It is more like a stock ticker tape than a ski slope.” NAMS recommends several nutraceuticals to help relieve mild menopausal symptoms, such as hot flashes, including combining dietary isoflavones, black cohosh or vitamin E with lifestyle changes, rather than conventional estrogen therapy.¹²

Isoflavones, found in both soy and in herbs such as red clover, have been investigated for their ability to mitigate menopausal symptoms. Red clover isoflavones were found by Dutch researchers to reduce the severity and occurrence of hot flashes in postmenopausal women.¹³ Over the 12-week study, women received 80 mg/d of red clover isoflavones as Promensil™ from Novogen Ltd. or placebo; those on the isoflavone treatment had a 44 percent reduction in hot flash frequency.

Preparations of black cohosh (Cimicifuga racemosa), made from the dried root, have been studied for anti-inflammatory, hypoglycemic and hypotensive effects. In addition, the triterpenoid glycosides, its primary active constituents, have effects similar those of estrogen. A review in American Family Physician noted black cohosh, when standardized to the terpene glycoside fraction, “appears to be effective in alleviating menopausal symptoms. Adverse reactions are extremely uncommon and there are no known significant adverse drug interactions.”¹⁴

Companies are also rolling out formulas based on Eastern healing traditions. HERBALmax, a formula based on Traditional Chinese Medicine, makes use of Asian botanicals to alleviate menopausal symptoms, said Nancy Zhang, president of HERBALmax. In a company-sponsored, open-label trial of 108 patients seeking treatment for menopause symptoms, 85 percent reported symptom improvement within three weeks, including improvements in depressed mood, hot flashes, fatigue and low sexual energy. In a second open-label trial of 60 women seeking treatment for depressed mood, 95 percent reported symptom improvement with respect to mood, energy and concentration.

Himalaya USA formulated its MenoCare® product with adaptogens like Ashwagandha plus Indian botanicals like Shatavari and Haritaki to improve hormone utilization and support hormone balance. A companysponsored study in 28 women taking MenoCare for three months reported marked relief from a variety of discomforts with no adverse side effects. Occurrences of hot flashes decreased by 96.2 percent, night sweating by 100 percent and insomnia by 71 percent; laboratory results showed a 70 percent increase in estrogen and a 39 percent decrease in FSH.

These adaptogens are shown useful not only in alleviating menopausal symptoms, but also in supporting sexual function. “We’ve seen a real awareness develop regarding women’s sexual health issues as they become more prevalent, through better diagnosing and higher awareness, and the causes better understood,” said Mandy Kraynik, director of scientific research for Europharma, makers of Confiance Sexual Desire Formula for Women. “Sex should be integrated as part of, not apart from, a woman’s overall wellness efforts and should be incorporated into a comprehensive lifestyle approach.”

The Confiance formula was designed to enhance libido and maintain balance in the female hormonal system. “Also, knowing sexual health is complex and is influenced by many factors, this formulation also addresses circulatory health, energy and immune health, which are all important factors in determining a woman’s sense of sexual desire and health,” Kraynik added. In a clinical study of 68 male and 52 female patients using the Libido Blend found in Confiance, there was an 88 percent improvement rate.¹⁵

Ethnobotanist Chris Kilham, who formulated the Hot Plants™ sexual enhancement product line for Enzymatic Therapy, noted there are a range of nutritional and botanical options available for supporting sexual function. “In terms of improving libido and enhancing pleasure, women in their 40s, 50s and beyond will find benefit from several types of adaptogenic herbs such as Rhodiola rosea, Ashwagandha and Siberian ginseng,” he said. He added other South American botanicals, such as maca and catuaba, have also been seen to enhance libido through as-yet-unknown means.

The hormonal changes continue into a woman’s 50s, further influencing her overall health. “As women progress into their 50s and beyond, high blood pressure, heart problems, bone and joint problems (such as osteoporosis) and stroke become important concerns,” Zhang said. “Proper nutrition and exercise should continue to play a major role in efforts to maintain good health.”

With the aging boomer population, more women are entering menopause and are looking for ways to stay active and healthy as long as possible. “While women seem to understand the common side effects associated with menopause, they are less likely to be aware of the increased risk factors for heart disease and osteoporosis created by the hormonal changes occurring during menopause,” Clow said. “A menopausal woman should choose a multivitamin formula with broad spectrum antioxidant support, since antioxidants may help reduce the risk of heart disease.” Rainbow Light is one company offering a targeted menopausal multi, which includes its MenoEase blend of botanicals such as black cohosh and soy isoflavones, plus nutrients to enhance energy and combat stress.

One such beneficial nutrient may be resveratrol, found in grapeseed extract and Polygonum cuspidatum. Trans-resveratrol has been found to enhance estrogen metabolism, helping women maintain normal estrogen activity, balance mood swings, maintain bone density and promote cardiovascular health.¹⁶ 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 flashes, mood swings and bone strength.¹⁷ Its ability to support heart health is also critical in this population of aging women.

“Heart disease remains the number one killer of women and osteoporosis is still a major issue despite the claims of hormone replacement therapy in preventing either of these conditions,” Lucille said. “Education, prevention and safe natural products are needed to decrease these risks and help women age healthfully.”

Women appear to share many traditional risk factors for coronary heart disease (CHD) with men, but also have significant differences, according to researchers.¹⁸ “Emerging” risk factors include dyslipidemia, lipoprotein (a) levels, hyperhomocysteinemia and oxidative stress; these are all associated with a greater CHD risk than the same condition in men. Women also have higher levels of fibrinogen (a protein necessary for blood clotting), which has been associated with increased CHD risk.

In addition, women are generally not treated as aggressively for cardiovascular disease as men. The Heart and Estrogen Replacement Study (HERS), conducted at the University of Alabama Birmingham, found the risk of fatal and non-fatal heart attacks increases up to six times in women when other factors such as diabetes, lack of exercise, high cholesterol and high blood pressure are present.¹⁹ However, they also discovered preventive drugs are underused in this population, especially among women at greatest risk, and that there are certain risk factors that are more telling in women. “Angina may be more atypical; diabetes and hypertriglyceridemia may be more important risk factors and need more aggressive treatment; and we are still trying to figure out the proper way to handle menopause,” said Andrew Miller, M.D., HERS project coordinator. “Women may be getting the shorter end of the stick and the whole system needs to do better.”

Soy, which has been shown beneficial in alleviating menopausal symptoms, also has application in the heart health arena. “Numerous studies show eating a diet rich in soy protein has several heart health benefits,” Burdak said. “The body of evidence is so significant that the Food and Drug Administration (FDA) released a claim stating ‘25 g of soy protein a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of coronary heart disease.’”

The benefits of soy protein in supporting women’s heart health have been shown in population studies. The Shanghai Women’s Health Study, which included approximately 65,000 Chinese women aged 40 to 70 years at the start of the three-year survey, found a dose-response relationship between soy food intake and risk of total CHD, and pronounced association for nonfatal heart attack.²⁰ Another recent study on soy protein and cholesterol in hypercholesterolemic men and women found soy protein, regardless of its isoflavone content, decreased LDL cholesterol and made it less atherogenic.²¹

Soy may also hold benefits in the fight against osteoporosis. “Preliminary research suggests soy protein may be a viable option for maintaining good bone health,” Burdak said. Indeed, in a population study of more than 450 Chinese women within the first 12 years of menopause, researchers found a dose-response relationship with increasing bone mineral density with increasing soy protein intake.22 And in a double blind study of 42 women on soy protein or milk protein for three months, both diets increased markers of bone formation, but soy protein reduced markers of bone resorption (breakdown) while milk protein did not.23 Also, milk protein increased urinary calcium excretion compared to the soy diet.

Whatever a woman’s age, it is a retailer’s responsibility to help educate her about the nutritional options available, and to guide her toward products that will enhance her well-being. “A number of studies show us that women use more supplements at all life stages than men do,” Talbott said. “Part of this finding is that women tend to be more aware of preventive health and ‘forward thinking’ about what the future might bring. Retailers should continue to educate women that preventive health is the way to go—it’s a much more prudent approach to prevent a problem than to try to fix one after it has taken root.”

The first step is for retailers to educate themselves, Otto said. “The more they understand about the reproductive life of a woman and the natural remedies that can be of assistance, the more they can sell what they have on the shelves,” she noted. Kilham agreed, adding, “Retailers educate their customers by being well informed and repeating accurate information, by making credible literature available to customers, by selling credible, well-written books, and by hosting seminars given by well-informed experts.”

Many companies offer handouts such as vitamin charts, health tips and product information sheets. In addition, a number of them will supply speakers for seminars that the retailer can host at her store. “Often, retailers are able to garner free local publicity if the subject matter of a seminar is enticing,” said Lisa Joski, customer service rep with EuroPharma. “Customers find in-store programs, and customized store fliers that mention specific products, to be most helpful. People visit health food stores for the expert service and information that they provide, so simply listening and talking one-on-one with customers provides outstanding service that keeps customers coming back.”

The one-on-one discussion is critical to ascertaining the best nutritional products for the customer. “Ask the customer questions,” Clow said. “What kind of support is she looking for? Does she have any special dietary restrictions, nutritional needs or health concerns? Is she willing to take three to six tablets per day, or would she prefer one tablet per day, or a multivitamin powder? Consumers are far more likely to stick with a supplement regimen if it is tailored to their specific needs, and if they are able to feel the difference the supplement creates in their health.”

Finally, retailers can help their customers understand their own “circle of life.” “It is important to remember the health of the 30s is based on the diet of the 20s and the health of the 40s is based on the diet and lifestyle of the 30s,” Sickert said. “It is a decade-by-decade process, and it is difficult to ‘undo’ a decade of poor diet.”

By helping their female customers take charge of their health in every decade of their lives, retailers will build long-term loyalty and help these women realize optimal health, whatever their age.

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