Lisa Olivo, Associate Editor05.01.14
From moms to millennials to the menopausal—women make up a significant audience in the health and wellness segment, with unique needs representing different phases of their lives.
As of 2013, Mintel reported that women made up slightly more than half (50.8%) of the U.S. population, but because the general population is aging, it’s anticipated the population of women aged 65-74 will grow by 21.1% from 2013-2018.
Moreover, the World Health Organization (WHO) reported that life expectancy for women over the age of 50 is growing internationally. While environmental and behavioral factors affect life expectancy from country to country, the WHO found women on average live longer than men. The global population of older women is also projected to increase from 12% in 2011 to 19% in 2050.
Despite a longer life expectancy, females face a variety of specific health concerns, ranging from cardiovascular disease to reproductive health to bone health, weight management and more. Perhaps because of this, women have been found to be more proactive about their health than men. Mintel reported that women tend to engage in more healthy habits than men, such as exercise, healthy eating and cessation of smoking. In addition, a poll from the market research firm showed women on average were more likely than men to use vitamins, minerals and supplements, with use among woman increasing with age (see Figure 1).
“Over the past four decades, we have seen changes in the supplement market as women increasingly become more proactive in researching the products they need, purchasing the products that reflect research and education investment, and advocating for the products from which they see results,” said Sébastien Bornet, director of global marketing for Switzerland-based Horphag Research.
Mr. Bornet cited a 2013 Gallup poll that found 54% of U.S. women took vitamins or supplements regularly, further demonstrating the role of preventive health routines in women’s lives. “As supplement use becomes increasingly more common, there’s a trend toward education and an interest in long-term health instead of quick fixes. Because of this, finding products that are natural and backed by clinical evidence are important to women.”
Menstrual Support
The pain experienced during a menstrual period, or dysmenorrhea, is the leading cause of recurrent short-term school absences in adolescent girls, and is a common problem in women of reproductive age. Popular treatments for dysmenorrhea include non-steroidal anti-inflammatory drugs (NSAID), oral contraceptives and hormone injections. However, many women prefer a natural approach.
A randomized, double-blind, placebo-controlled study found that dysmenorrhea could be significantly reduced with supplementation of Horphag’s proprietary ingredient Pycnogenol, an antioxidant plant extract from the bark of the French maritime pine tree. Female subjects aged 18-48 suffering from menstrual pain who used Pycnogenol reported less pain during menstruation, which was reflected by a significant reduction of NSAID use. The number of painful days due to dysmenorrhea decreased from an average of 2.1 days prior to treatment, to 1.3 after 3-4 months of use.
In addition, Pycnogenol along with oral contraceptives were recently shown to minimize pain and inflammation associated with endometriosis and may help eliminate dysmenorrhea. A study published in the Journal of Women’s Health found that after three months of supplementation Pycnogenol significantly increased the efficacy of oral contraceptives for the treatment of endometriosis-related pain.
In addition, studies have shown Pycnogenol may be effective in treating the symptoms of pre-menstrual syndrome (PMS).
According to the American Congress of Obstetricians and Gynecologists, at least 85% of women who menstruate have at least one premenstrual symptom, which include bloating and weight gain, acne, anxiety, achiness, breast tenderness, cramps, depression and food cravings. Multiple clinical studies have shown supplementation with Pycnogenol, a natural anti-inflammatory, can reduce menstrual discomfort, especially cramping and abdominal pain.
Omega-3s may also help attenuate physical and psychological symptoms of PMS, according to Dr. Wael Massrieh, vice president of scientific affairs for Neptune Technologies & Bioressources Inc., Laval, Quebec, Canada. A recent randomized, double-blind clinical trial involving 70 women of reproductive age compared Neptune Krill Oil (NKO) for the management of PMS to omega-3 18:12 fish oil over the course of 3 months.
“Both the physical (such as breast tenderness or swelling, headaches, joint or muscle pain, weight gain) and emotional (overwhelmed, stress, irritable, depression) symptoms were assessed at baseline and at the end of the treatment period,” Dr. Massrieh said. Results found a statistically significant improvement between baseline and final evaluation. “Interestingly, not only did NKO show superiority to omega-3 fish oil in improving physical symptoms, but it also had marked improvement on all emotional symptoms.”
Describing NKO’s effectiveness in treating the mood-related symptoms of PMS, he noted, “evidence has shown that phospholipids of the brain have an especially high content of the long-chain omega-3 DHA, and these phospholipid species are centrally involved in brain function. The effectiveness of NKO on emotional menstrual symptoms may thus be based on potential modulating effects on neurotransmitters that affect emotional and psychological symptoms.”
Nurturing Maternal Health
The ability to bear children adds a variety of health concerns and considerations that are unique to women.
Dean Mosca, president of Proprietary Nutritionals Inc. (PNI), Kearny, NJ, suggested, “Women tend to become more interested in creating and sustaining a healthier life that includes supplementation when they start considering having a family—before the first baby. This may be anywhere in their mid 20s to late 30s. And this healthy mindset often remains stable and prominent the rest of their lives.”
A range of prenatal vitamins today offer pregnant and breastfeeding women the essential vitamins, minerals and nutrients needed to protect themselves from complications, and ensure the health of their child.
Multivitamins are a great option for pregnant women looking to fill nutritional gaps, according to Eric Ciappio, PhD, RD, scientific leader at DSM Nutritional Products, Parsippany, NJ. “Women of childbearing age are recommended to consume 400 micrograms of folic acid/day to reduce the risk of having a child with neural tube defects. Furthermore, the nutritional requirement for iron in adult women (18 mg/day) is more than twice that of men (8 mg/day), and many women fall short of the recommendation. Both folic acid and iron have been listed as ‘Nutrients of Public Health Concern’ by the 2010 Dietary Guidelines Advisory Committee.”
A recent study published in the Journal of Perinatal Medicine demonstrated a low dose ferrous bisglycinate chelate (in the form of AminoJern, a product containing Ferrochel from Albion Human Nutrition, St. Clair Shores, MI) to be equivalent to a higher dose ferrous salt with regard to hematological and iron status when used by expectant women. This finding is significant as it may help pregnant women prevent iron deficiency and iron deficiency anemia, which can be detrimental to the developing fetus. According to the study, a low dose of ferrous iron from 15-19 weeks of gestation resulted in a lower incidence of gastrointestinal distress (which often accompanies higher doses of iron) and healthier baby birth weights.
Adding to the list of specific nutritional needs for pregnant women, Max Motyka, MS, RPh, director of sales and marketing at Albion, stressed the importance of proper magnesium supplementation during pregnancy. “Pre-eclampsia, and pre-term births are associated with abnormally low levels of magnesium in the blood during pregnancy. Magnesium supplementation has been shown to improve these risks.”
Mr. Motyka also noted the importance of zinc during pregnancy, referencing research published in the Journal of the American Medical Association, which “demonstrated that zinc supplementation improved growth in extremely low birth weight infants with chronic lung disease.”
Other side effects of pregnancy (and motherhood in general) often include lack of sleep and diminished energy. However, pregnant and nursing mothers need to be extra cautious about what they are putting in their bodies. To offer energy support to the pregnant and post-partum, New York, NY-based Healthy Mama has developed a caffeine-free energy drink designed specifically for moms. The all-natural mango flavored Boost It Up! contains 7 grams of protein for energy and to help fetal growth; B vitamins for an energy boost; 250 mg of ginger to reduce nausea; electrolytes for hydration and leg cramping; and 3 grams of fiber for digestive support.
Menopause & Healthy Aging
As women end their reproductive life and enter into menopause, it can be both physically trying and emotionally difficult. As the ovaries cease to function, and stop producing the hormones estrogen and progesterone, women may experience hot flashes, sleep difficulties, vaginal dryness, urinary incontinence, mood changes and anxiety, and decreased bone density. Women may also experience forgetfulness, night sweats, weight fluctuation and joint and muscle aches or stiffness.
To balance changing hormone levels naturally, many women look to plant-based phytoestrogens for support. “Phytoestrogens are natural components from plants which bind to estrogen receptors in the body,” explained Jacqui Justice, MS, CNS, director of nutrition for Womens Healthy Hormones, Tarrytown, NY. “Make no mistake, phytoestrogens are not actually estrogen, but since they are capable of binding to estrogen receptors, they can ‘fool’ the body into thinking and reacting as though there were more estrogen present.” For example, she cited a study published in the journal Alternative and Complementary Therapies, which showed licorice root helped to balance estrogen and progesterone levels in women.
DSM’s Dr. Ciappio referenced a study that indicated supplementing with 30 mg/day of genistein, a phytoestrogen derived from soy, for 12 weeks reduced the number of hot flashes in menopausal women by 51%. “Another recent study showed that genistein has important benefits for bone health; women supplementing with 30 mg/day of genistein, along with other key bone supporting nutrients like vitamin K, vitamin D and omega-3 fatty acids, saw significant improvements in bone mineral density.”
HMRlignan, from Switzerland-based Linnea, assists menopausal women with help from a group of chemical compounds found in plants that are among the major classes of phytoestrogens. Donald Brown, ND, managing director of Natural Product Research Consultants, Seattle, WA, explained HMRlignan “in low doses (compared, for instance, to flax lignan supplements) effectively raises enterolactone levels. Higher circulating enterolactone levels have been associated with improved breast health in both premenopausal and postmenopausal women.”
Furthermore, a recent study in the Journal of the American College of Nutrition found use of HMRlignan in postmenopausal women ages 50-75 resulted in a 55% reduction in the number of hot flashes after 4 weeks of supplementation when taken at higher levels (72 mg/d). The study’s subjects receiving this dosage also experienced 50% reduction in hot flashes after 8 weeks of continued supplementation.
Gene Bruno, MS, MHS, director of category management for Twinlab Corporation, New York, NY, pointed to the power of hops extract and black cohosh in modulating hormonal balance in women. Twinlab recently introduced Dual Action Menopause Response, which combines these extracts to help relieve hot flashes, night sweats, nervousness, moodiness, sleeplessness and vaginal dryness, in addition to supporting menopause-related sexual function.
“Hops extract provides plant estrogens that may bind to primary estrogen receptors in the female reproductive system and may help to smooth out some of the rough spots as the body adjusts to its new hormonal norm during menopausal years,” Mr. Bruno said. “With multiple human clinical trials behind it, the clinically tested amount of 80 mg of black cohosh extract (provided in a daily serving of two capsules) works with neurotransmitters or by other support mechanisms to help address a variety of menopause symptoms.”
Novel Ingredient Services, West Caldwell, NJ, offers EstroG-100, a blend of Cynanchum wilfordii (cinnamic acid), Phlomis umbrosa (shanzhiside methyl ester), and Angelica gigas nakai (nodakenin). These ingredients work synergistically to modulate estrogenic activity selectively and moderate the many symptoms of menopause.
In addition to supporting symptoms associated with menstruation, Pycnogenol offers support for women during perimenopause and menopause. Because Pycnogenol assists vascular relaxation, it allows the body to rid itself of excess body heat, reducing the sensation of hot flashes and nighttime sweating. This improved vascular function also has indications for improving cardiovascular health, another key health issue for women.
Urinary Tract Health
In the U.S., nearly 10 million annual doctor visits are attributed to urinary tract infections (UTIs), with more than $1 billion dollars spent per year on treatment, noted PNI’s Mr. Mosca. “It is the second most common infection in women; 80% of all women will experience a UTI in their lifetime and approximately 20% of women will have a UTI each year.” UTIs are also the second leading cause of lost workdays for women.
Dan Souza, senior director of sales and marketing - DBS Division for Naturex, Avignon, France, added that urinary tract infection is the second most common infection in the world. “One in two women will suffer from a UTI at some point in their lives while one third of those women will suffer from recurrent UTI. Recurrent UTI sufferers are proactively seeking out all-natural, safe and effective solutions to reduce their UTI recurrence rates.”
Cranberry is a widely recognized holistic approach to preventing urinary tract infections that is available in supplements, functional foods and beverages.
PNI’s Cran-Max consists of a proprietary cranberry concentrate, not an extract. “Eleven clinical studies show supplementing with Cran-Max supports urinary tract health, and one landmark study showed that Cran-Max was as effective as the number-one prescribed antibiotic for preventing recurrent urinary tract infection,” Mr. Mosca said. “This new test method adds even more support for the urinary health benefits of Cran-Max, as well as the mechanism of the Bio-Shield delivery system, since it shows that the large majority of PACs (proanthocyanidins) in Cran-Max are bound to the cranberry fiber.”
Naturex’s Pacran ingredient boasts clinically-proven efficacy, as well as low sugar and calorie content. “Pacran has virtually no calories or sugars,” Mr. Souza noted. “Cranberry foods and beverages, like cranberry juice cocktail and sweetened and dried cranberries, are loaded with over 100 calories and over 25 grams of sugar per serving.”
In addition to cranberry, Naturex also produces Utirose, a hibiscus extract clinically proven to support urinary tract health in women. “Clinical trials demonstrated a significant reduction in the incidence of urinary infections after 3 and 6 months and an improvement of urinary well-being in women,” noted Mr. Souza.
A collaboration between Fruit d’Or Nutraceuticals, Quebec City, Canada, and UAS LifeSciences, Madison, WI, resulted in a cranberry based supplement to treat UTIs with added probiotics for vaginal flora health, all in one supplement. UP4 Women’s consists of a blend of Cran Naturelle, a 100% all-natural, whole food, GMO-free, organic cranberry rich in proanthocyanidins; as well as probiotic strains Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus plantarum, Lactobacillus gasseri and Bifidobacterium lactis.
Novel Ingredient Services also offers a unique ingredient for urinary tract health: UT-Pro. Derived from glucose, UT-Pro can be used in dietary supplements, functional foods and other health products to support urinary tract health with the aid of D-mannose. Mannose is a natural carbohydrate prevalent in many fruits and vegetables that has been found to support urinary tract health because its chemical structure is similar to that of the intestinal flora. Mannose is not well metabolized by the human body, so it can directly enter the bloodstream from the GI tract, where it is primarily filtered through the kidneys and bladder. Upon entering the urinary tract, D-mannose binds to the unwanted flora in the urinary tract lining and rinses the bacteria away during urination.
Battle of the Bulge
Excess weight negatively affects quality of life and shortens lifespan. In fact, being overweight is the second leading cause of preventable death for adults in the U.S., according to the Centers for Disease Control and Prevention.
The American Obesity Association reported that women who are overweight have nearly four times the risk of developing osteoarthritis as women at a healthy weight. Additionally, excess weight has been linked to a higher risk of developing breast cancer; a higher risk of neural tube defects during pregnancy; three to four times the risk for endometrial cancer; at least twice the risk for gallbladder disease; and complications with infertility and urinary stress incontinence. Cardiovascular disease is also a significant concern for overweight women, especially those middle to older age.
Mintel reported that women account for 48% of the 154.7 million Americans who are overweight or obese. Overall, 54% of women are overweight or obese (based on BMI calculations from self-reported height and weight), with the majority of these women 35 or older.
Nutratech, Inc., West Caldwell, NJ, offers its proprietary bitter orange (Citrus aurantium) extract Advantra Z, which is positioned to support weight loss, fitness and energy. “Women are recognizing they need to be more active in order to help manage their weight,” said Bob Green, president of Nutratech. “As an assist, they look for supplement ingredients that pack a multi-powered punch to address weight management and energy issues.”
An all-natural, thermogenic ingredient, Advantra Z has been tested in more than 30 research studies. Among these, Mr. Green pointed to an examination of the dietary supplement Metabo—which contains Advantra Z—that found improvements in body composition, waist and hip girth when paired with 8-weeks of exercise and dietary support (Journal of the International Society of Sports Nutrition, April 2013).
Mr. Green also cited a trial conducted by Dr. Christine Haller at the University of California, San Francisco, whom he referred to as a “staunch critic of performance-enhancing dietary supplements.” Dr. Haller’s study, published in the British Journal of Clinical Pharmacology (2008), found that exercise was easier 83% of the time—and no significant adverse events occurred—following use of a performance-enhancing dietary supplement containing Advantra Z.
Strengthening Bones
Data from the National Osteoporosis Foundation indicate osteoporosis impacts 52 million Americans, of which 68% are women. Key nutrients like calcium, vitamin D, magnesium and vitamin K support preservation of bone mass. As women enter menopause they are particularly susceptible to low bone density and osteoporosis as their hormone levels decline.
According to Mintel, three quarters of female supplement users aged 55+ took vitamins, minerals and supplements to keep their bones healthy. Brands looking to appeal to this audience should consider delivery forms such as gummies or dissolvable strips, as women 55+ expressed interest in these novel formats.
“Osteoporosis is largely avoidable,” said Albion’s Mr. Motyka. “Given the proper nutrients, the body can repair bone damage at any age. It is never too late, but the earlier women recognize the essential need for adequate nutrient consumption, particularly calcium and magnesium, the more osteoporosis can be prevented.”
While the benefits of calcium are well known, magnesium deficiency is a frequently occurring disorder that leads to loss of bone mass, abnormal bone growth and skeletal weakness, according to Mr. Motyka.
He referenced a recent study, which set out to explore whether magnesium deficiency affects the formation and/or activity of osteoclasts, which are instrumental in controlling the amount of bone tissue in the body. “Bone marrow cells were studied in medium containing different concentrations of magnesium. Magnesium deficiency resulted in increased numbers of osteoclast-like cells. Increased development of osteoclasts due to magnesium deficiency was reflected in higher expression of osteoclast-related genes. The data suggest that altered osteoclast numbers and activity may contribute to the skeletal characteristics seen in magnesium deficient patients.”
In addition, vitamin D deficiency is a serious threat to bone health. DSM’s Dr. Ciappio reported that 90% of adults do not meet the recommended daily intake for vitamin D. “Adequate calcium intake is especially important for younger women as well, but 77% of teenage girls do not meet the recommended intake of calcium from food alone. Both calcium and vitamin D have been listed as ‘Nutrients of Public Health Concern’ by the 2010 Dietary Guidelines Advisory Committee, and it is essential for women to meet the recommendations for these nutrients from foods and supplements to best support bone health.”
Vitamin K, which acts as a “chaperone” for calcium and prevents arterial calcification, plays an important role in preserving bone health. Oslo, Norway-based Kappa Bioscience offers a pure vitamin K2 menaquinone-7 for various formulations in the supplement and fortified food market. The company claims its K2VITAL ingredient is the first man-made form of menaquionone-7. As such, it was manufactured to be free from substances like milk, egg and soy proteins, lactose and gluten, which make it a more tolerable form of vitamin K for those with allergies or intolerances.
NattoPharma, Oslo, Norway, also specializes in vitamin K, with its MenaQ7 ingredient derived from the traditional Japanese fermented soy dish natto. “Up to 98% of the general population is insufficient in vitamin K, especially vitamin K2, for functions supporting healthy bones, the cardiovascular system and the metabolic system,” according to Vladimir Badmaev, MD, PhD, head of R&D, NattoPharma ASA. “Since vitamin K’s important role at the molecular level is as a calcium chaperone, its supplementation—in combination with calcium and vitamin D—is particularly important.”
Healthy Heart
Heart disease is the number one killer among women, according to the American Heart Association, and 60% of all stroke victims are female. An estimated 43 million women in the U.S are affected by heart disease, and it causes one in three deaths each year—killing approximately one woman every minute.
Moreover, Hispanic and African-American women are more likely to suffer from heart problems. Hispanic women are more likely to develop heart disease a full 10 years earlier than Caucasian women, and 46.9% of African-American women ages 20 and older have cardiovascular disease.
“There can be no doubt that cardiovascular disease should be a key concern in women’s health today,” said Barbara Davis, Ph.D., RD- director, medical and scientific affairs for PLT Health Solutions, Morristown, NJ.
To assist women in combating this epidemic, PLT offers Hytolive olive fruit extract, a 100% natural, solvent-free water extract containing a high concentration of natural hydroxytyrosol. “Hydroxytyrosol is the major phenolic compound found in olives and provides a great part of the health benefits of both olive fruit and virgin olive oil. In 2011, the European Food Safety Authority (EFSA) approved a heart health claim for olive oil polyphenols—the most important of which is hydroxytyrosol—for cardiovascular health. EFSA considers that polyphenols in olives—standardized by their content of hydroxytyrosol—as sufficiently characterized in relation to the claimed effects,” said Dr. Davis.
Sytrinol, a patented proprietary blend of polymethoxylated flavones and tocotrienols, is designed to keep cardiovascular disease (CVD) at bay.
“When estrogen levels drop, CVD in women increases to the same rates as their male counterparts,” noted Deanne Dolnick, vice president of Next Pharmaceuticals, Salinas, CA. “I strongly recommend Sytrinol for women once they hit the age of 45. Keeping cholesterol levels in check is one of the most important ways to keep the heart healthy. Clinical research has shown that Sytrinol significantly lowers total cholesterol and LDL-cholesterol.”
Mood, Stress & Sleep
Modern day lifestyles can often lead to higher levels of stress and anxiety. Mintel data showed women were more likely to suffer from anxiety, depression and trouble sleeping, and they reported a higher rate of stress in their lives than their male counterparts.
According to Mintel, when asked about what lifestyle factors most contribute to overall health, women were most likely to cite a positive mental state (even more so than eating healthy and getting sufficient sleep).
Albion’s Mr. Motyka noted that women are 70% more likely than men to experience depression in their lifetime. “Evidence is building on the role magnesium plays in the central nervous system,” he said. “Preclinical and clinical studies have implicated a relationship between magnesium homeostasis and the emotions of fear, anxiety and depression.”
In a study published in Neuropharmacology, researchers investigated previously found evidence that magnesium had an effect on mood, emotions and reactions to stress. “In this study, the researchers observed that magnesium deficiency caused an increase in the transcription of the corticotrophin-releasing hormone in the periventricular hypothalamic nucleus, and elevated ACTH plasma levels,” according to Mr. Motyka. “This indicates an enhanced set point in the HPA [Hypothalamic-Pituitary-Adrenal] axis. They saw that this disregulation of the HPA axis could contribute to hyper-emotionality, as a response to dietary induced hypomagnesemia.”
Twinlab’s Mr. Bruno pointed to L-theanine, an amino acid found in the tea plant (Camellia sinensis) as a nutraceutical to promote relaxation and attenuate stress. This amino acid can be found in Twinlab’s L-Theanine Dots, a chewable supplement used to increase the activity of alpha waves in the brain, resulting in a state of relaxation without causing drowsiness.
“L-theanine supports mental alertness while promoting relaxation,” explained Mr. Bruno. “Additionally, a clinical study found that 200 mg of L-theanine, the amount provided in four dots, may help reduce some measures of stress in as little as 15 minutes.”
Next Pharmaceuticals’ Relora is a patented, proprietary blend of Magnolia officinalis and Phellodendron amurense extracts used to alleviate stress and anxiety. The company’s Ms. Dolnick described the most recent trial on Relora, which found the product decreased cortisol levels by 18% compared to placebo. “It does this by helping to calm the HPA axis,” she said. “The HPA axis is always being stimulated, but in some people it is constantly over-stimulated, which leads to an excess secretion of cortisol. Cortisol levels that are consistently raised can lead to a litany of health problems including but not limited to increased inflammatory markers throughout the body (heart disease, osteoarthritis), Alzheimer’s disease and sleep deprivation.”
High cortisol levels have also been linked to increased belly fat in women, as well as a greater risk of heart disease and metabolic syndrome.
Next Pharmaceuticals also offers Seditol, a patented, proprietary blend of Magnolia officinalis extract and Ziziphus spinosa seed extract for use as a natural sleep aid.
Moving Ahead…
As manufacturers continue to develop new and innovative products to meet the needs of the modern woman, they can rest assured that demand for preventive healthcare is resolute.
With the rollout of the Patient Protection and Affordable Care Act (often referred to as “Obamacare”) experts at Mintel anticipate that increased access to affordable medical assistance could further pique interest for women looking to improve their health. Yearly “Well Woman” check-ups covered by Obamacare will introduce previously uncovered women to a better relationship with their healthcare provider, and perhaps motivate them to take more proactive steps toward safeguarding their health. Affordable, over-the-counter supplements stand to gain a large, newly empowered audience of women looking to improve or maintain their health.
As of 2013, Mintel reported that women made up slightly more than half (50.8%) of the U.S. population, but because the general population is aging, it’s anticipated the population of women aged 65-74 will grow by 21.1% from 2013-2018.
Moreover, the World Health Organization (WHO) reported that life expectancy for women over the age of 50 is growing internationally. While environmental and behavioral factors affect life expectancy from country to country, the WHO found women on average live longer than men. The global population of older women is also projected to increase from 12% in 2011 to 19% in 2050.
Despite a longer life expectancy, females face a variety of specific health concerns, ranging from cardiovascular disease to reproductive health to bone health, weight management and more. Perhaps because of this, women have been found to be more proactive about their health than men. Mintel reported that women tend to engage in more healthy habits than men, such as exercise, healthy eating and cessation of smoking. In addition, a poll from the market research firm showed women on average were more likely than men to use vitamins, minerals and supplements, with use among woman increasing with age (see Figure 1).
“Over the past four decades, we have seen changes in the supplement market as women increasingly become more proactive in researching the products they need, purchasing the products that reflect research and education investment, and advocating for the products from which they see results,” said Sébastien Bornet, director of global marketing for Switzerland-based Horphag Research.
Mr. Bornet cited a 2013 Gallup poll that found 54% of U.S. women took vitamins or supplements regularly, further demonstrating the role of preventive health routines in women’s lives. “As supplement use becomes increasingly more common, there’s a trend toward education and an interest in long-term health instead of quick fixes. Because of this, finding products that are natural and backed by clinical evidence are important to women.”
Menstrual Support
The pain experienced during a menstrual period, or dysmenorrhea, is the leading cause of recurrent short-term school absences in adolescent girls, and is a common problem in women of reproductive age. Popular treatments for dysmenorrhea include non-steroidal anti-inflammatory drugs (NSAID), oral contraceptives and hormone injections. However, many women prefer a natural approach.
A randomized, double-blind, placebo-controlled study found that dysmenorrhea could be significantly reduced with supplementation of Horphag’s proprietary ingredient Pycnogenol, an antioxidant plant extract from the bark of the French maritime pine tree. Female subjects aged 18-48 suffering from menstrual pain who used Pycnogenol reported less pain during menstruation, which was reflected by a significant reduction of NSAID use. The number of painful days due to dysmenorrhea decreased from an average of 2.1 days prior to treatment, to 1.3 after 3-4 months of use.
In addition, Pycnogenol along with oral contraceptives were recently shown to minimize pain and inflammation associated with endometriosis and may help eliminate dysmenorrhea. A study published in the Journal of Women’s Health found that after three months of supplementation Pycnogenol significantly increased the efficacy of oral contraceptives for the treatment of endometriosis-related pain.
In addition, studies have shown Pycnogenol may be effective in treating the symptoms of pre-menstrual syndrome (PMS).
According to the American Congress of Obstetricians and Gynecologists, at least 85% of women who menstruate have at least one premenstrual symptom, which include bloating and weight gain, acne, anxiety, achiness, breast tenderness, cramps, depression and food cravings. Multiple clinical studies have shown supplementation with Pycnogenol, a natural anti-inflammatory, can reduce menstrual discomfort, especially cramping and abdominal pain.
Omega-3s may also help attenuate physical and psychological symptoms of PMS, according to Dr. Wael Massrieh, vice president of scientific affairs for Neptune Technologies & Bioressources Inc., Laval, Quebec, Canada. A recent randomized, double-blind clinical trial involving 70 women of reproductive age compared Neptune Krill Oil (NKO) for the management of PMS to omega-3 18:12 fish oil over the course of 3 months.
“Both the physical (such as breast tenderness or swelling, headaches, joint or muscle pain, weight gain) and emotional (overwhelmed, stress, irritable, depression) symptoms were assessed at baseline and at the end of the treatment period,” Dr. Massrieh said. Results found a statistically significant improvement between baseline and final evaluation. “Interestingly, not only did NKO show superiority to omega-3 fish oil in improving physical symptoms, but it also had marked improvement on all emotional symptoms.”
Describing NKO’s effectiveness in treating the mood-related symptoms of PMS, he noted, “evidence has shown that phospholipids of the brain have an especially high content of the long-chain omega-3 DHA, and these phospholipid species are centrally involved in brain function. The effectiveness of NKO on emotional menstrual symptoms may thus be based on potential modulating effects on neurotransmitters that affect emotional and psychological symptoms.”
Nurturing Maternal Health
The ability to bear children adds a variety of health concerns and considerations that are unique to women.
Dean Mosca, president of Proprietary Nutritionals Inc. (PNI), Kearny, NJ, suggested, “Women tend to become more interested in creating and sustaining a healthier life that includes supplementation when they start considering having a family—before the first baby. This may be anywhere in their mid 20s to late 30s. And this healthy mindset often remains stable and prominent the rest of their lives.”
A range of prenatal vitamins today offer pregnant and breastfeeding women the essential vitamins, minerals and nutrients needed to protect themselves from complications, and ensure the health of their child.
Multivitamins are a great option for pregnant women looking to fill nutritional gaps, according to Eric Ciappio, PhD, RD, scientific leader at DSM Nutritional Products, Parsippany, NJ. “Women of childbearing age are recommended to consume 400 micrograms of folic acid/day to reduce the risk of having a child with neural tube defects. Furthermore, the nutritional requirement for iron in adult women (18 mg/day) is more than twice that of men (8 mg/day), and many women fall short of the recommendation. Both folic acid and iron have been listed as ‘Nutrients of Public Health Concern’ by the 2010 Dietary Guidelines Advisory Committee.”
A recent study published in the Journal of Perinatal Medicine demonstrated a low dose ferrous bisglycinate chelate (in the form of AminoJern, a product containing Ferrochel from Albion Human Nutrition, St. Clair Shores, MI) to be equivalent to a higher dose ferrous salt with regard to hematological and iron status when used by expectant women. This finding is significant as it may help pregnant women prevent iron deficiency and iron deficiency anemia, which can be detrimental to the developing fetus. According to the study, a low dose of ferrous iron from 15-19 weeks of gestation resulted in a lower incidence of gastrointestinal distress (which often accompanies higher doses of iron) and healthier baby birth weights.
Adding to the list of specific nutritional needs for pregnant women, Max Motyka, MS, RPh, director of sales and marketing at Albion, stressed the importance of proper magnesium supplementation during pregnancy. “Pre-eclampsia, and pre-term births are associated with abnormally low levels of magnesium in the blood during pregnancy. Magnesium supplementation has been shown to improve these risks.”
Mr. Motyka also noted the importance of zinc during pregnancy, referencing research published in the Journal of the American Medical Association, which “demonstrated that zinc supplementation improved growth in extremely low birth weight infants with chronic lung disease.”
Other side effects of pregnancy (and motherhood in general) often include lack of sleep and diminished energy. However, pregnant and nursing mothers need to be extra cautious about what they are putting in their bodies. To offer energy support to the pregnant and post-partum, New York, NY-based Healthy Mama has developed a caffeine-free energy drink designed specifically for moms. The all-natural mango flavored Boost It Up! contains 7 grams of protein for energy and to help fetal growth; B vitamins for an energy boost; 250 mg of ginger to reduce nausea; electrolytes for hydration and leg cramping; and 3 grams of fiber for digestive support.
Menopause & Healthy Aging
As women end their reproductive life and enter into menopause, it can be both physically trying and emotionally difficult. As the ovaries cease to function, and stop producing the hormones estrogen and progesterone, women may experience hot flashes, sleep difficulties, vaginal dryness, urinary incontinence, mood changes and anxiety, and decreased bone density. Women may also experience forgetfulness, night sweats, weight fluctuation and joint and muscle aches or stiffness.
To balance changing hormone levels naturally, many women look to plant-based phytoestrogens for support. “Phytoestrogens are natural components from plants which bind to estrogen receptors in the body,” explained Jacqui Justice, MS, CNS, director of nutrition for Womens Healthy Hormones, Tarrytown, NY. “Make no mistake, phytoestrogens are not actually estrogen, but since they are capable of binding to estrogen receptors, they can ‘fool’ the body into thinking and reacting as though there were more estrogen present.” For example, she cited a study published in the journal Alternative and Complementary Therapies, which showed licorice root helped to balance estrogen and progesterone levels in women.
DSM’s Dr. Ciappio referenced a study that indicated supplementing with 30 mg/day of genistein, a phytoestrogen derived from soy, for 12 weeks reduced the number of hot flashes in menopausal women by 51%. “Another recent study showed that genistein has important benefits for bone health; women supplementing with 30 mg/day of genistein, along with other key bone supporting nutrients like vitamin K, vitamin D and omega-3 fatty acids, saw significant improvements in bone mineral density.”
HMRlignan, from Switzerland-based Linnea, assists menopausal women with help from a group of chemical compounds found in plants that are among the major classes of phytoestrogens. Donald Brown, ND, managing director of Natural Product Research Consultants, Seattle, WA, explained HMRlignan “in low doses (compared, for instance, to flax lignan supplements) effectively raises enterolactone levels. Higher circulating enterolactone levels have been associated with improved breast health in both premenopausal and postmenopausal women.”
Furthermore, a recent study in the Journal of the American College of Nutrition found use of HMRlignan in postmenopausal women ages 50-75 resulted in a 55% reduction in the number of hot flashes after 4 weeks of supplementation when taken at higher levels (72 mg/d). The study’s subjects receiving this dosage also experienced 50% reduction in hot flashes after 8 weeks of continued supplementation.
Gene Bruno, MS, MHS, director of category management for Twinlab Corporation, New York, NY, pointed to the power of hops extract and black cohosh in modulating hormonal balance in women. Twinlab recently introduced Dual Action Menopause Response, which combines these extracts to help relieve hot flashes, night sweats, nervousness, moodiness, sleeplessness and vaginal dryness, in addition to supporting menopause-related sexual function.
“Hops extract provides plant estrogens that may bind to primary estrogen receptors in the female reproductive system and may help to smooth out some of the rough spots as the body adjusts to its new hormonal norm during menopausal years,” Mr. Bruno said. “With multiple human clinical trials behind it, the clinically tested amount of 80 mg of black cohosh extract (provided in a daily serving of two capsules) works with neurotransmitters or by other support mechanisms to help address a variety of menopause symptoms.”
Novel Ingredient Services, West Caldwell, NJ, offers EstroG-100, a blend of Cynanchum wilfordii (cinnamic acid), Phlomis umbrosa (shanzhiside methyl ester), and Angelica gigas nakai (nodakenin). These ingredients work synergistically to modulate estrogenic activity selectively and moderate the many symptoms of menopause.
In addition to supporting symptoms associated with menstruation, Pycnogenol offers support for women during perimenopause and menopause. Because Pycnogenol assists vascular relaxation, it allows the body to rid itself of excess body heat, reducing the sensation of hot flashes and nighttime sweating. This improved vascular function also has indications for improving cardiovascular health, another key health issue for women.
Urinary Tract Health
In the U.S., nearly 10 million annual doctor visits are attributed to urinary tract infections (UTIs), with more than $1 billion dollars spent per year on treatment, noted PNI’s Mr. Mosca. “It is the second most common infection in women; 80% of all women will experience a UTI in their lifetime and approximately 20% of women will have a UTI each year.” UTIs are also the second leading cause of lost workdays for women.
Dan Souza, senior director of sales and marketing - DBS Division for Naturex, Avignon, France, added that urinary tract infection is the second most common infection in the world. “One in two women will suffer from a UTI at some point in their lives while one third of those women will suffer from recurrent UTI. Recurrent UTI sufferers are proactively seeking out all-natural, safe and effective solutions to reduce their UTI recurrence rates.”
Cranberry is a widely recognized holistic approach to preventing urinary tract infections that is available in supplements, functional foods and beverages.
PNI’s Cran-Max consists of a proprietary cranberry concentrate, not an extract. “Eleven clinical studies show supplementing with Cran-Max supports urinary tract health, and one landmark study showed that Cran-Max was as effective as the number-one prescribed antibiotic for preventing recurrent urinary tract infection,” Mr. Mosca said. “This new test method adds even more support for the urinary health benefits of Cran-Max, as well as the mechanism of the Bio-Shield delivery system, since it shows that the large majority of PACs (proanthocyanidins) in Cran-Max are bound to the cranberry fiber.”
Naturex’s Pacran ingredient boasts clinically-proven efficacy, as well as low sugar and calorie content. “Pacran has virtually no calories or sugars,” Mr. Souza noted. “Cranberry foods and beverages, like cranberry juice cocktail and sweetened and dried cranberries, are loaded with over 100 calories and over 25 grams of sugar per serving.”
In addition to cranberry, Naturex also produces Utirose, a hibiscus extract clinically proven to support urinary tract health in women. “Clinical trials demonstrated a significant reduction in the incidence of urinary infections after 3 and 6 months and an improvement of urinary well-being in women,” noted Mr. Souza.
A collaboration between Fruit d’Or Nutraceuticals, Quebec City, Canada, and UAS LifeSciences, Madison, WI, resulted in a cranberry based supplement to treat UTIs with added probiotics for vaginal flora health, all in one supplement. UP4 Women’s consists of a blend of Cran Naturelle, a 100% all-natural, whole food, GMO-free, organic cranberry rich in proanthocyanidins; as well as probiotic strains Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus plantarum, Lactobacillus gasseri and Bifidobacterium lactis.
Novel Ingredient Services also offers a unique ingredient for urinary tract health: UT-Pro. Derived from glucose, UT-Pro can be used in dietary supplements, functional foods and other health products to support urinary tract health with the aid of D-mannose. Mannose is a natural carbohydrate prevalent in many fruits and vegetables that has been found to support urinary tract health because its chemical structure is similar to that of the intestinal flora. Mannose is not well metabolized by the human body, so it can directly enter the bloodstream from the GI tract, where it is primarily filtered through the kidneys and bladder. Upon entering the urinary tract, D-mannose binds to the unwanted flora in the urinary tract lining and rinses the bacteria away during urination.
Battle of the Bulge
Excess weight negatively affects quality of life and shortens lifespan. In fact, being overweight is the second leading cause of preventable death for adults in the U.S., according to the Centers for Disease Control and Prevention.
The American Obesity Association reported that women who are overweight have nearly four times the risk of developing osteoarthritis as women at a healthy weight. Additionally, excess weight has been linked to a higher risk of developing breast cancer; a higher risk of neural tube defects during pregnancy; three to four times the risk for endometrial cancer; at least twice the risk for gallbladder disease; and complications with infertility and urinary stress incontinence. Cardiovascular disease is also a significant concern for overweight women, especially those middle to older age.
Mintel reported that women account for 48% of the 154.7 million Americans who are overweight or obese. Overall, 54% of women are overweight or obese (based on BMI calculations from self-reported height and weight), with the majority of these women 35 or older.
Nutratech, Inc., West Caldwell, NJ, offers its proprietary bitter orange (Citrus aurantium) extract Advantra Z, which is positioned to support weight loss, fitness and energy. “Women are recognizing they need to be more active in order to help manage their weight,” said Bob Green, president of Nutratech. “As an assist, they look for supplement ingredients that pack a multi-powered punch to address weight management and energy issues.”
An all-natural, thermogenic ingredient, Advantra Z has been tested in more than 30 research studies. Among these, Mr. Green pointed to an examination of the dietary supplement Metabo—which contains Advantra Z—that found improvements in body composition, waist and hip girth when paired with 8-weeks of exercise and dietary support (Journal of the International Society of Sports Nutrition, April 2013).
Mr. Green also cited a trial conducted by Dr. Christine Haller at the University of California, San Francisco, whom he referred to as a “staunch critic of performance-enhancing dietary supplements.” Dr. Haller’s study, published in the British Journal of Clinical Pharmacology (2008), found that exercise was easier 83% of the time—and no significant adverse events occurred—following use of a performance-enhancing dietary supplement containing Advantra Z.
Strengthening Bones
Data from the National Osteoporosis Foundation indicate osteoporosis impacts 52 million Americans, of which 68% are women. Key nutrients like calcium, vitamin D, magnesium and vitamin K support preservation of bone mass. As women enter menopause they are particularly susceptible to low bone density and osteoporosis as their hormone levels decline.
According to Mintel, three quarters of female supplement users aged 55+ took vitamins, minerals and supplements to keep their bones healthy. Brands looking to appeal to this audience should consider delivery forms such as gummies or dissolvable strips, as women 55+ expressed interest in these novel formats.
“Osteoporosis is largely avoidable,” said Albion’s Mr. Motyka. “Given the proper nutrients, the body can repair bone damage at any age. It is never too late, but the earlier women recognize the essential need for adequate nutrient consumption, particularly calcium and magnesium, the more osteoporosis can be prevented.”
While the benefits of calcium are well known, magnesium deficiency is a frequently occurring disorder that leads to loss of bone mass, abnormal bone growth and skeletal weakness, according to Mr. Motyka.
He referenced a recent study, which set out to explore whether magnesium deficiency affects the formation and/or activity of osteoclasts, which are instrumental in controlling the amount of bone tissue in the body. “Bone marrow cells were studied in medium containing different concentrations of magnesium. Magnesium deficiency resulted in increased numbers of osteoclast-like cells. Increased development of osteoclasts due to magnesium deficiency was reflected in higher expression of osteoclast-related genes. The data suggest that altered osteoclast numbers and activity may contribute to the skeletal characteristics seen in magnesium deficient patients.”
In addition, vitamin D deficiency is a serious threat to bone health. DSM’s Dr. Ciappio reported that 90% of adults do not meet the recommended daily intake for vitamin D. “Adequate calcium intake is especially important for younger women as well, but 77% of teenage girls do not meet the recommended intake of calcium from food alone. Both calcium and vitamin D have been listed as ‘Nutrients of Public Health Concern’ by the 2010 Dietary Guidelines Advisory Committee, and it is essential for women to meet the recommendations for these nutrients from foods and supplements to best support bone health.”
Vitamin K, which acts as a “chaperone” for calcium and prevents arterial calcification, plays an important role in preserving bone health. Oslo, Norway-based Kappa Bioscience offers a pure vitamin K2 menaquinone-7 for various formulations in the supplement and fortified food market. The company claims its K2VITAL ingredient is the first man-made form of menaquionone-7. As such, it was manufactured to be free from substances like milk, egg and soy proteins, lactose and gluten, which make it a more tolerable form of vitamin K for those with allergies or intolerances.
NattoPharma, Oslo, Norway, also specializes in vitamin K, with its MenaQ7 ingredient derived from the traditional Japanese fermented soy dish natto. “Up to 98% of the general population is insufficient in vitamin K, especially vitamin K2, for functions supporting healthy bones, the cardiovascular system and the metabolic system,” according to Vladimir Badmaev, MD, PhD, head of R&D, NattoPharma ASA. “Since vitamin K’s important role at the molecular level is as a calcium chaperone, its supplementation—in combination with calcium and vitamin D—is particularly important.”
Healthy Heart
Heart disease is the number one killer among women, according to the American Heart Association, and 60% of all stroke victims are female. An estimated 43 million women in the U.S are affected by heart disease, and it causes one in three deaths each year—killing approximately one woman every minute.
Moreover, Hispanic and African-American women are more likely to suffer from heart problems. Hispanic women are more likely to develop heart disease a full 10 years earlier than Caucasian women, and 46.9% of African-American women ages 20 and older have cardiovascular disease.
“There can be no doubt that cardiovascular disease should be a key concern in women’s health today,” said Barbara Davis, Ph.D., RD- director, medical and scientific affairs for PLT Health Solutions, Morristown, NJ.
To assist women in combating this epidemic, PLT offers Hytolive olive fruit extract, a 100% natural, solvent-free water extract containing a high concentration of natural hydroxytyrosol. “Hydroxytyrosol is the major phenolic compound found in olives and provides a great part of the health benefits of both olive fruit and virgin olive oil. In 2011, the European Food Safety Authority (EFSA) approved a heart health claim for olive oil polyphenols—the most important of which is hydroxytyrosol—for cardiovascular health. EFSA considers that polyphenols in olives—standardized by their content of hydroxytyrosol—as sufficiently characterized in relation to the claimed effects,” said Dr. Davis.
Sytrinol, a patented proprietary blend of polymethoxylated flavones and tocotrienols, is designed to keep cardiovascular disease (CVD) at bay.
“When estrogen levels drop, CVD in women increases to the same rates as their male counterparts,” noted Deanne Dolnick, vice president of Next Pharmaceuticals, Salinas, CA. “I strongly recommend Sytrinol for women once they hit the age of 45. Keeping cholesterol levels in check is one of the most important ways to keep the heart healthy. Clinical research has shown that Sytrinol significantly lowers total cholesterol and LDL-cholesterol.”
Mood, Stress & Sleep
Modern day lifestyles can often lead to higher levels of stress and anxiety. Mintel data showed women were more likely to suffer from anxiety, depression and trouble sleeping, and they reported a higher rate of stress in their lives than their male counterparts.
According to Mintel, when asked about what lifestyle factors most contribute to overall health, women were most likely to cite a positive mental state (even more so than eating healthy and getting sufficient sleep).
Albion’s Mr. Motyka noted that women are 70% more likely than men to experience depression in their lifetime. “Evidence is building on the role magnesium plays in the central nervous system,” he said. “Preclinical and clinical studies have implicated a relationship between magnesium homeostasis and the emotions of fear, anxiety and depression.”
In a study published in Neuropharmacology, researchers investigated previously found evidence that magnesium had an effect on mood, emotions and reactions to stress. “In this study, the researchers observed that magnesium deficiency caused an increase in the transcription of the corticotrophin-releasing hormone in the periventricular hypothalamic nucleus, and elevated ACTH plasma levels,” according to Mr. Motyka. “This indicates an enhanced set point in the HPA [Hypothalamic-Pituitary-Adrenal] axis. They saw that this disregulation of the HPA axis could contribute to hyper-emotionality, as a response to dietary induced hypomagnesemia.”
Twinlab’s Mr. Bruno pointed to L-theanine, an amino acid found in the tea plant (Camellia sinensis) as a nutraceutical to promote relaxation and attenuate stress. This amino acid can be found in Twinlab’s L-Theanine Dots, a chewable supplement used to increase the activity of alpha waves in the brain, resulting in a state of relaxation without causing drowsiness.
“L-theanine supports mental alertness while promoting relaxation,” explained Mr. Bruno. “Additionally, a clinical study found that 200 mg of L-theanine, the amount provided in four dots, may help reduce some measures of stress in as little as 15 minutes.”
Next Pharmaceuticals’ Relora is a patented, proprietary blend of Magnolia officinalis and Phellodendron amurense extracts used to alleviate stress and anxiety. The company’s Ms. Dolnick described the most recent trial on Relora, which found the product decreased cortisol levels by 18% compared to placebo. “It does this by helping to calm the HPA axis,” she said. “The HPA axis is always being stimulated, but in some people it is constantly over-stimulated, which leads to an excess secretion of cortisol. Cortisol levels that are consistently raised can lead to a litany of health problems including but not limited to increased inflammatory markers throughout the body (heart disease, osteoarthritis), Alzheimer’s disease and sleep deprivation.”
High cortisol levels have also been linked to increased belly fat in women, as well as a greater risk of heart disease and metabolic syndrome.
Next Pharmaceuticals also offers Seditol, a patented, proprietary blend of Magnolia officinalis extract and Ziziphus spinosa seed extract for use as a natural sleep aid.
Moving Ahead…
As manufacturers continue to develop new and innovative products to meet the needs of the modern woman, they can rest assured that demand for preventive healthcare is resolute.
With the rollout of the Patient Protection and Affordable Care Act (often referred to as “Obamacare”) experts at Mintel anticipate that increased access to affordable medical assistance could further pique interest for women looking to improve their health. Yearly “Well Woman” check-ups covered by Obamacare will introduce previously uncovered women to a better relationship with their healthcare provider, and perhaps motivate them to take more proactive steps toward safeguarding their health. Affordable, over-the-counter supplements stand to gain a large, newly empowered audience of women looking to improve or maintain their health.
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In vitro and in vivo data suggest AHCC can eliminate HPV infections and may have a role in the prevention of HPV-related cancers. Treating cervical cancer cells with Japanese mushroom extract Active Hexose Correlated Compound (AHCC) led to the eradication of human papillomavirus (HPV), as well as a decrease in the rate of tumor growth in vitro and in vivo, in research presented at the Society of Gynecological Oncology 45th Annual Meeting on Women’s Cancer in Tampa, FL. The study was led by Dr. Judith Smith, PharmD, at the University of Texas Health Science Center (UTHealth) Medical School at Houston. In the study, cervical cancer cells were treated with AHCC and incubated for 72 hours with sampling every 24 hours. The study was then repeated in two orthotopic mouse models, one HPV positive and other HPV negative control. The HPV expression was eradicated with once daily AHCC dosing for 90 days with durable response after 30-day observation off treatment. Dr. Smith then repeated the study to confirm findings and added sampling for correlative testing of immune markers to determine the mechanism by which AHCC eradicates the HPV virus. These data suggest AHCC can eliminate HPV infections and may have a role in the prevention of HPV-related cancers. A confirmatory pilot study in HPV and women is underway at UTHealth Women’s Center. HPV is the most common sexually transmitted virus in the U.S. Up to 70% of sexually active adults will acquire HPV at some point in their lives. Human papillomavirus DNA has been detected in 99.7% of cervical cancer biopsies, yielding the largest causative relationship of any cancer. For more information: www.ahccresearch.org |
