A Teetering Market for Women's Health

I'm a woman
Phenomenally.
Phenomenal woman,
That's me.

- Maya Angelou
Phenomenal Woman

The contagious title, Men are from Mars, Women are from Venus has become a cliché depiction of the differences between a man and a woman. Granted, the book discusses relational matters, but the title does hold some truth applicable to men and womens health in that physiologically, men and women are from different planets. Women exclusively experience menstrual cycles, pregnancy and menopause, just to name a few. And because of the diverse health issues facing womenfrom breast cancer to menopausethe womens health market is multifaceted.
Women tend to understand the needs of their bodies better than men, said Mitch Skop, senior director of new product development, Pharmachem Laboratories. Whether the questions go to the pros and cons of estrogen therapy or prenatal nutrition, women have always been at the forefront of health and wellness.
Even though women are taking an active (and proactive) role in their health, their market is full of confusion, debatable research and misinformation. Current research is fueling debates over the age women should start getting mammograms, the pros and cons of hormone replacement therapy (HRT) and many other female issues.
The recent news about a recommendation that women dont need annual mammograms until after age 50 sparked an intense national debate that proves women are serious about their health and are intent on taking preventive measuresnot only for breast health, but in all areas, said Dean Mosca, president, Proprietary Nutritionals Inc. And this is very good news for the naturals industry.
Natural is looking better and better compared to the conventional arena, as there are many side effects to pharmacological and conventional approaches attempting to tackle womens health issues. The market for womens health products that incorporate natural ingredients is growing dramatically, said Bob Green, president, Nutratech. This is primarily due to the negative side effects from traditional medicines. Just consider the well-publicized complications surrounding HRT. But also, there is a general consumer trend toward all things natural.
Some issues women face are not as publicized as breast cancer or hot flashes; nonetheless, they need tackling. For example, the current market for iron supplements is served by pharmaceutical/over-the-counter (OTC) companies that offer iron supplements based on old iron sources and outdated formulations, said Scott Hagerman, president and CEO of Chemi Nutra. The majority of these products are not well tolerated, causing stomach upset, heartburn and constipation, and often ending in withdrawal. Many, if not most of the population who are in need of an iron supplementation lack even basic knowledge of iron deficiency. These facts are especially interesting when considering that essentially every pregnant woman and every person clinically diagnosed with iron deficiency and anemia are given a prescription for an iron supplement.
Brazilian research found pregnant women supplementing 15 mg/d of Ferrochel® (from Albion), an iron bis-glycinate chelate, was significantly more effective, in spite the lower dose, compared to 40 mg/d of ferrous sulfate, commonly used to treat iron deficiency.¹ The effect of supplementation was evaluated by measuring hemoglobin, transferrin saturation and serum ferritin at the beginning of the study (less than 20 weeks pregnancy) and at 20 to 30 weeks and 30 to 40 weeks thereafter. A total of 73 percent of the Ferrochel-consuming group and 35 percent of the ferrous sulfate-consuming group were considered to have taken the treatment adequately. The decrease in levels of all the measured parameters was significantly less pronounced in the group consuming Ferrochel, in spite of the lower treatment dose. Iron depletion was found in 30.8 percent of the women treated with Ferrochel and 54.5 percent of the women that consumed ferrous sulfate. Of the factors responsible for non-compliance, taste was reported in 29 percent of the ferrous sulfate consumers, with no complaints from the Ferrochel group.
Sifting through the many ailments and issues women face is not an easy task. The multifaceted womens health market is driving upward, but, on its way up, its seeing many changes. Originally, the womens health category was focused on female-specific health concerns like menopause and bone support, but were seeing a growing understanding of the issue of obesity and being overweight as an underlying risk factor in numerous womens health concerns, Green said.
Hagerman agreed, adding, Nutrition science and medical discovery have brought about much more information on womens health issues in the past one to two decades.
FDA is also making waves as it changes the face of the dietary supplement industry as a whole, including the womens health market. Weve seen much more FDA scrutiny of the market, particularly for weight-control products, which has been long overdue, Skop said. Products that promise miracle weight-loss results are being pulled from the shelves, and were seeing our industry do a better job of calling to task unscrupulous marketers. Skop also noted the recent emphasis on clinical studies and substantiated product claims and the continual focus of safety and efficacy. This is important to mention because it affects women, he said. Women will become highly skeptical. Although they are very willing to try something new, they dont like pie-in-the-sky, unfulfillable promises.

The Bodys Basics

Even though men can be inflicted with them as well, urinary tract infections (UTI) are a common ailment in women. According to Sherry Torkos, a holistic pharmacist and author, 80 percent of women will experience a UTI in their lifetime, and approximately 20 percent of women will have a UTI each year. A total of 9.6 million U.S. doctor visits per year are attributed to UTIs, and they are the second leading cause of lost work days for women.
The immediate response to a UTI is usually to call the doctor and get a prescription for an antibiotic. But research is proving the power of the cranberry. Many women are plagued by recurrent UTIs, and simply have no time for this discomforting annoyance, said Mosca. They know cranberry is the bladder/urinary tracts best nutrition buddy.
In 2009, researchers found Trimethoprim, an antibiotic commonly prescribed for UTIs, had a very limited advantage over cranberry extract (as Cran-Max®, from Proprietary Nutritionals) in the prevention of recurrent UTIs in older women and had more adverse effects.² A total of 137 women with two or more antibiotic-treated UTIs in the previous 12 months were randomized to receive either 500 mg of cranberry extract or 100 mg of trimethoprim for six months. Thirty-nine of 137 participants (28 percent) had an antibiotic-treated UTI (25 in the cranberry group and 14 in the trimethoprim group). The time to first recurrence of UTI was not significantly different between the groups. The median time to recurrence of UTI was 84.5 days for the cranberry group and 91 days for the trimethoprim group.
Cranberry extract was also studied in patients with a spinal cord injury. A randomized, double blind, placebo-controlled trial with a crossover design gave a cranberry extract (as Cran-Max) or a placebo to subjects with a spinal cord injury and documentation of neurogenic bladder for six months, followed by the alternate preparation for an additional six months.³ A reduction in the likelihood of UTI and symptoms for any month while receiving the cranberry tablet was observed.

Weighed Down

If women were known for one universal struggle, weight management would win unanimously. The battle waging over weight seems endless (whether overweight or underweight), and balancing nutrition and exercise isnt as easy as it seems.
Beyond specific issues, such as support for menopause and post-menopausal cardiovascular and bone health, attaining a healthy weight and attractive figure is paramount for women of all ages, beginning in their teens, Skop said. Weight management is an issue for women of all ages, not only for health reasons, but appearance as well. Recent statistics show the number of overweight and obese Americans continues to rise despite increased efforts to educate them about the importance of controlling weight. Consequently, we continue to see strong interest and growth in ingredients that can help women control their weight. Consumers, in general, need assistance in the battle against the bulge.
Diet pills, yo-yo diets and quick fixes seem to be the dominant weighty answers women are looking for. But from slowing down the glycemic response to speeding up metabolism, the natural products industry has a few answers of its own.
In 2009, researchers evaluated a concentrated northern kidney bean extract (as Phase 2 Carb Controller, from Pharmachem Laboratories) in the inhibition of carbohydrate metabolism and absorption and its ability to decrease calorie intake and promote weight loss.⁴ In two single-dose human studies, 11 fasting subjects were given four slices of white bread and 42 g of margarine with or without 1.5 g of bean extract. A full-meal study with seven subjects and 0.75 g of the bean extract caused a non-significant 28- to 41-percent reduction in absorption. There was also a dose-response decrease in glucose absorption by the extract. Researchers found the bean extract had in vivo efficacy for inhibition of starch absorption and may prove beneficial in weight reduction in individuals consuming large amounts of starch. They said it also may inhibit starch-induced hyperglycemia in normal and diabetic subjects.
Additionally, an open-label, six-arm crossover study including 13 randomized subjects found the addition of 3,000 mg of Phase 2 Carb Controller in powder form significantly reduced the glycemic index of Wonder Brand White Bread.⁵ As a bonus, participants receiving 1,500 mg of Phase 2 for eight weeks versus those receiving an identical placebo twice daily lost an average of 3.79 lbs. compared to 1.65 lbs., respectively. Triglyceride levels in the Phase 2 group were reduced to an average of 26.3 mg/dL, more than three times greater a reduction than observed in the placebo group.
On a faster note, Canadian researchers sped up metabolism with a bitter orange extract. When given with a meal, a Citrus aurantium extract (as Advantra Z®, from Nutratech Inc.) increased the thermic effect of food, although the effect was more pronounced in men than in women.⁶ And, without adversely affecting blood pressure, Citrus aurantium (as Advantra Z) also increased epinephrine excretion by 2.4 times.⁷

Breast Cancer

An overwhelming fear for women is breast cancer. Women across the world crusade for funds, awareness, prescreening and financial support for more research, all in the name of breast cancer. Research on the matter is expanding and spicing things up with curcumin or eating a pomegranate for breakfast may work preventively.
In November 2009, research supported the use of curcumin and piperine as potential cancer preventive agents.⁸ Mammosphere formation assays were performed after curcumin, piperine and a control treatment were administered in unsorted normal breast epithelial cells and normal stem and early progenitor cells. Both curcumin and piperine inhibited mammosphere formation, serial passaging and percent of aldehyde dehydrogenase (ALDH) + cells by 50 percent at 5 M and completely at 10 M concentration in normal and malignant breast cells. There was no effect on cellular differentiation. Wnt signaling was inhibited by both curcumin and piperine by 50 percent at 5 M and completely at 10 M. The study concluded curcumin and piperine separately, and in combination, inhibit breast stem cell self-renewal, but do not cause toxicity to differentiated cells.
Starting the morning off with a glass of pomegranate juice or munching on its juicy seeds may pay off, as a study published in Cancer Prevention Research found pomegranates may prevent estrogen-responsive breast cancers.⁹ Phytochemicals ellagitannins (ET), found in pomegranates, inhibited aromatase, a key enzyme used by the body to make estrogen that also plays a key role in breast cancer growth.
And even though controversial, soy has been shown to reduce the risk of breast cancer recurrence. JAMA reported women in China who had breast cancer and a higher intake of soy food had an associated lower risk of death and breast cancer recurrence.¹⁰ Patients in the group with the highest intake of soy protein had a 29-percent lower risk of death during the study period, and a 32-percent lower risk of breast cancer recurrence compared to patients with the lowest intake of soy protein. However, the American Journal of Clinical Nutrition reported no association between phytoestrogen intake and breast cancer in women, or between phytoestrogen intake and colorectal cancer in men.¹¹
The role of phytoestrogens in womens health, in particular breast health, has been the subject of debate for several years, said Ellen Kamhi, Ph.D., R.N., professional herbalist, nutritionist for Bio-Botanica. Another study was just published in The Proceedings of the Nutrition Society. Researchers concluded there is increasing evidence that phytoestrogens may be beneficial, even in women with estrogen sensitive cancers.
The in vitro study evaluated the possible role of Pueraria mirifica (PM; as Puresterol®, from Bio-Botanica), indigenous to Thailand, a root belonging to the Papilionaceae (Leguminosae) family that has been used in Asian culture for many centuries, in the management of breast cancer.¹² Cell growth studies over four days indicated low-growth rates for the PM-treated cells with an increasing effect over time that appeared to reach significance by day three or four when compared with untreated cells.

Menopause/Mood

Of course, the inevitable for every woman is menopause. This unique and individualized transition affects every woman differently. From hot flashes to mood swings, these symptoms can begin at different ages. Some women experience terrible symptoms, while others encounter few or none.
Women often develop myriad health issues linked to hormone imbalance, Kamhi said. Although a majority of these are believed to start in midlife with the onset of menopause, in fact, a dysfunctional pattern can begin during adolescent years or even at a younger age.
According to the Natural Marketing Institutes (NMI) 2009 Supplements/Rx/OTC Database, of those women who indicated they use supplements, only 2 percent indicated usage of supplements for menopause in the past 30 days.
Fluctuating estrogen and progesterone levels are commonplace as women age, but during menopause the side effects of these fluctuationshot flashes, mood swings, decreased libido and memory impairment, to name a few, can be particularly difficult to deal with, Kamhi said. The common use in conventional medicine of HRT was once believed to be a panacea that would solve many of these problems. However, there have been disappointing scientific findings concerning the safety and efficacy of hormone replacement therapy.
Herbal treatments and natural remedies are becoming popular alternatives to problems associated with menopause. The European Journal of Clinical Nutrition reported among overweight/obese postmenopausal women, coffee consumption was negatively associated with C-reactive protein (CRP) and appeared to attenuate the association between body mass index (BMI) and CRP, but only in women not using HRT.¹³
PM has also been shown to not only inhibit the growth of breast cancer cells, but stave off menopausal discomforts. Kamhi cited two studies demonstrating PMs effect on menopause. In a Phase III, Thai-funded study PM demonstrated promise in staving off discomforts associated with menopause.¹⁴ A separate  study reported on PM as a potential source of phytoestrogens for postmenopausal women.¹⁵
Kamhi noted, Sayan Sawatsri, M.D., working with Emory University Department of Obstetrics and Gynecology in Atlanta, presented an unpublished paper on his research on PM, which concluded: PM may constitute a new class of treatment, safe, low toxicity, showing natural SERMs [selective estrogen receptor modulator] properties, agonist in specific tissues and antagonist in other tissues, in vitro and in vivo models.
Additionally, a separate study published in Menopause found PM exhibited estrogenicity on vaginal tissue by alleviating vaginal dryness symptoms and dyspareunia, and improving signs of vaginal atrophy, and restoring the atrophic vaginal epithelium in healthy postmenopausal women.¹⁶
Memory loss is another common side effect of menopause. Over the past several years, the medical community has been looking at the association HRT and the impairment of mental performance that often accompanies HRT, Hagerman said. Chemi Nutras SerinAid® PhosphatidylSerine (PS) was evaluated in a research study at the University of Guadalajara in Mexico, involving PS and its ability to reduce the incidence of memory loss that accompanies HRT in women. In the final report, the researcher commented that PS improved various emotional aspects related to HRT.

Into the Future

With the broadness of the womens health sector, market growth is expected. Theres no doubt that the category will continue to grow, Green said. It will involve virtually every health issue facing womenfrom anti-aging, bone, joint and cardiovascular health to emotional well-being, neural health and mental acuity, as well as reproductive and urinary tract health.
We are optimistic about the future of dietary supplements, functional beverages and fortified foods expressly for women, Skop said. Suppliers and finished-product manufacturers know that women do their product research; they are willing to engage in trial, seek to be loyal to a product/brand, engage in word-of-mouth endorsements for those products they like, and are on a constant quest to be healthy.

References on the next page...

References for Women's Health

1.       Szarfarc SC, Nunez et al. Relative Effectiveness Of Iron Bis-Glycinate Chelate (Ferrochel®) And Ferrous Sulfate In The Control Of Iron Deficiency In Pregnant Women Archivos Latinoamericanos de Nutricion. S 51 (1) 2001:42-47

2.       Marion E. T. McMurdo1 et al. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women J Antimicrob Chemo. 2009 63(2):389-395

3.       M J Hess et al. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder Spinal Cord. 2009;46:622626

4.       Joe A. Vinson, Hassan Al Kharrat, Donna Shuta Investigation of an Amylase Inhibitor on Human Glucose Absorption after Starch Consumption Open Nutri J. 2009;2:88-91. DOI:10.2174/1876396000902010088;http://www.bentham.org/open/tonutraj/openaccess2.htm

5.       Udani J, Hardy M, Madsen DC Blocking carbohydrate absorption and weight loss: a clinical trial using Phase 2 brand proprietary fractionated white bean extract Altern Med Rev. 2004 Mar;9(1):63-9

6.       Gougeon R et al. Increase in the thermic effect of food in women by adrenergic amines extracted from citrus aurantium. Obes Res. 2005 Jul;13(7):1187-94.

7.       Haller CA, Benowitz NL, Jacob P 3^rd. Hemodynamic effects of ephedra-free weight-loss supplements in humans. Am J Med. 2005;8(9):998-1003.

8.       Madhuri Kakarala et al. Targeting breast stem cells with the cancer preventive compounds curcumin and piperine Breas Can Res Treat. Nov. 6, 2009; DOI: 10.1007/s10549-009-0612-x

9.       Lynn S. Adams, et al. Pomegranate EllagitanninDerived Compounds Exhibit Antiproliferative and Antiaromatase Activity in Breast Cancer Cells In vitro Cancer Prevent Res. (2009;3(1):10813)

10.   Xiao Ou Shu et al. Soy Food Intake and Breast Cancer Survival JAMA 2009;302(22):2483-2484

11.   Heather Ward et al. Breast, colorectal, and prostate cancer risk in the European Prospective Investigation into Cancer and NutritionNorfolk in relation to phytoestrogen intake derived from an improved database Am J Clin Nutr (Dec. 9, 2009). doi:10.3945/ajcn.2009.28282

12.   S. Ramnarine1, J. MacCallum2 and M. Ritchie Phyto-oestrogens: do they have a role in breast cancer therapy? Proceedings of the Nutrition Society 2009; DOI:10.1017/S0029665109990462

13.   B J Arsenault et al. Obesity, coffee consumption and CRP levels in postmenopausal overweight/obese women: importance of hormone replacement therapy use Eur J Clin Nutr. 2009;63:14191424

14.   J Med Assoc Thai. 2007;90(9)

15.   J Med Assoc Thai. 2005;88(1)

16.   Manonai, Jittima MD et al. Effect of Pueraria mirifica on vaginal health Menopause. 2007;14(5):919-924; DOI:10.1097/gme.0b013e3180399486