WOMENS HEALTH

WOMENS HEALTH
By Brooke K. Deets

Many conditions affecting women specifically including premenstral syndrome (PMS), premenstrual dysphoric disorder (PMDD, PMSs more severe counterpart) and menopauseare rooted in a womans hormone levels. Other conditions, such as heart disease, breast cancer and osteoporosis, are also related to the amount of hormones (or lack of) that a womans body produces. These conditions become more of a threat once a women reaches the age of menopause, when the levels of estrogen decline.

On the plus side, estrogen is responsible for proper functioning of a womans reproductive system, promotes bone growth, lowers insulin levels and relaxes blood vessels, leading to good circulatory health. But during menopause, when levels of estrogen and other sex hormones (such as progesterone) fluctuate, a new set of symptoms and health risks occur. For example, unopposed estrogen may lead to an accumulation of body fat, an overgrowth of breast tissue and an increased risk of blood clots.

In the recent past, hormone replacement therapy (HRT, a combination of estrogen and progestin, given to women with a uterus, as opposed to estrogen replacement therapy, ERT, for women without a uterus) has served as the main treatment menopausal women turned to for alleviating such symptoms. That is, of course, until the Womens Health Initiative study, conducted by the National Institutes of Health (NIH) was abruptly halted after five years because researchers found HRT actually increased the risk of heart disease, breast cancer and stroke.¹

Since NIH halted its trial, there has been a substantial decline in use of HRT by postmenopausal women.² In contrast, the use of alternative medicine, including natural remedies such as vitamins, minerals and herbs, by women to relieve the discomforts associated with menopause and reduce the risk of cardiovascular disease has remained strong. According to SPINS, a natural products industry market research firm based in San Francisco, women spent approximately $21.9 million on natural products for PMS and approximately $125.6 million on natural products for menopause the 52 weeks ending Feb. 21, 2004 approximately $1 million and $6 million more, respectively, than the 52 weeks ending Feb. 22, 2003.

PMS & Menopause

Premenstrual syndrome (PMS) is a collection of symptoms that includes menstrual cramps, bloating, breast tenderness, head and backaches, and mood swings. Symptoms may impact up to 95 percent of women, although it is estimated to affect 5 percent of women severely.³ And although the troubles associated with PMS may end with menopause, the post-menopausal phasewhich on average is at least one-third of a womans lifebrings with it a new set of discomforts (e.g., hot flashes, night sweats and loss of libido) and health concerns, including increased risk of atherosclerotic cardiovascular disease (CVD), osteoporosis and related fractures, and Alzheimers dementia.⁴

Menopause means the end of natural childbearing and is defined by the North American Menopause Society (NAMS) as the point after 12 months of amenorrhea (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. And interestingly, although life expectancy has increased over the last 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. NAMS also noted menopause is a significant public health issue because the condition affects all women, an unprecedented number of boomers are reaching midlife and more women are living beyond the age of 65. In fact, as of 2000, almost 40 million U.S. women reached natural menopause, with 1.4 million U.S. women reaching natural menopause in 2000 alone.

A number of vitamins, minerals and herbs are thought to contribute to womens health and aid hormone-related conditions, including PMS and menopause. Scientific evidence supports the role of calcium for example, in supporting cyclic fluctuations during the menstrual cycle, which may help reduce symptoms of PMS.⁵ The researchers from St. Lukes-Roosevelt Hospital Center in New York indicated PMS may represent a clinical manifestation of calcium deficiency. A study conducted at King James Medical Laboratory in Cleveland found similar data, and researchers concluded PMS may be related to calcium deficiency or a metabolic defect involving calcium.⁶ Researchers from the University of Michigan Medical Center, Ann Arbor, also indicated calcium may help reduce PMS symptoms.⁷

Supplementation with vitamin B6 may also help relieve PMS. A systematic review of the efficacy of the vitamin in the treatment of PMS suggested up to 100 mg/d would likely benefit PMS symptoms, as well as premenstrual depression.⁸ A study conducted at the University of Reading, Berkshire, England, demonstrated a small synergistic effect of daily supplementation with a combination of 200 mg of magnesium plus 50 mg of vitamin B6 in reducing mild premenstrual anxiety-related symptoms.⁹

A flavonoid supplement (as Colladeen from Lamberts Healthcare Ltd.) containing 320 mg oligomeric procyanidins from grapeseed and bilberry extracts, may help alleviate fluid retention associated with PMS.¹⁰ After four months of supplementation, women in the flavonoid group reported a decrease in premenstrual fluid retention, as well as a significant improvement in subjective leg health scores compared to placebo, although researchers reported no significant changes in leg girth measurement.

Another flavonoid source, French maritime pine bark extract, (as Pycnogenol from Natural Health Science Inc.), may also help with premenstrual dysfunction. Researchers at Keiju Medical Center in Nanao City, Japan, found menstrual cramps were reduced by 73 percent to 100 percent in women taking 30 mg/d for one month.¹¹ Another study by the same researchers found Pycnogenol reduces abdominal and lower back pain associated with menstruation; the study has been accepted for publication in The Journal of Reproductive Medicine.¹²

Upon nearing the onset of menopause, many women turn to herbal products to help relieve menopausal symptoms. Researchers from Wayne State University in Detroit said four botanicalsphytoestrogens (isoflavones), St. Johns wort, Ginkgo biloba and ginsengare commonly used.¹³ Of the 397 ethnically diverse women surveyed, approximately 25 percent reported taking at least one of the four botanicals in the previous six months, and 68 percent of those using the products said their symptoms improved. NAMS also recommends several nutraceuticals to help relieve mild menopause-related vasomotor symptoms (i.e. hot flashes), including combining dietary isoflavones, black cohosh or vitamin E with lifestyle changes, rather than conventional estrogen therapy.¹⁴ In its published evidence-based position statement, NAMS noted no serious side effects have been associated with long-term administration of soy foods and isoflavone supplements, black cohosh or vitamin E; however, clinical trials have been inconclusive as to their efficacy. The organization still recommends estrogen therapy for severe hot flashes, but noted clinical trials have associated estrogen therapy with adverse effects, including increased risks of breast cancer, stroke and thromboembolism.

A review of herbs commonly used by women conducted by researchers at the Medical College of Wisconsin, Milwaukee, supports the use of black cohosh for relieving symptoms of perimenopause, as well as the use of ginseng to improve overall well-being in perimenopausal women.¹⁵ Researchers from Baylor College of Medicine in Houston, however, concluded many trials of black cohosh in treating hot flashes had conflicting results and it was unclear whether black cohosh is more effective than placebo at reducing hot flash symptoms.¹⁶

Herbal combinations may also be effective for improving hormonerelated conditions. A proprietary herbal formula (as Femnia from Geni Herbs) was found to significantly improve menopausal symptoms including hot flashes, night sweats, insomnia and fatigue, as well as palpitation and anxiety in perimenopausal women.¹⁷ The results show all around improvement in all the subjective symptoms of menopause with use of Femnia when used in the dose of two capsules twice a day for three months, the researchers concluded. Other symptoms also improved, including libido, vaginal dryness, forgetfulness, depression and joint pain, although the difference was not statistically significant.

Red clover, an herb with phytoestrogenic properties, has shown promising results in treating menopausal symptoms. Research out of Amsterdam (Urije Universiteit Medical Centre) suggested red clover isoflavones could reduce the severity and occurrence of hot flashes in postmenopausal women.¹⁸ Thirty postmenopausal women were randomly assigned to receive either 80 mg/d of red clover isoflavones (as Promensil, marketed by Stamford, Conn.-based Novogen Ltd.) or placebo for 12 weeks; all women were assigned to receive placebo for four weeks at the beginning of the study. The researchers noted hot flash frequency was reduced by 16 percent in the initial four-week placebo period. However, subjects receiving isoflavones reported a 44-percent decrease in the occurrence of hot flashes during the treatment period, while there was no further reduction in women receiving placebo.

A study conducted at the University of California, San Francisco, also tested red clovers ability to provide relief from hot flashes and other symptoms of menopause. The researchers found 82 mg/d of red clover isoflavones (as Promensil) helped reduce hot flashes more rapidly than 57 mg/d of red clover isoflavones (as Rimostil, also from Novogen) or placebo, but concluded neither red clover supplement had a clinically important effect on hot flashes and related menopausal symptoms.¹⁹ In contrast, a systematic review of herbal medicinal products to treat menopausal symptoms conducted by English researchers suggested red clover may be of more benefit for more severe menopausal symptoms.²⁰

Isoflavones derived from soy also exert estrogenic effects on the body and may help to reduce menopause-related symptoms particularly hot flashesas well as improve post-menopausal cognitive function. After daily administration of 400 mg of a standardized soy extract (as SoySelect from Indena), corresponding to 50 mg/d of isoflavones, for six weeks, women experienced fewer and less severe hot flashes per week.²¹ A study of 75 menopausal women conducted at Hospital Edouard Herriot in Lyon, France, found similar results.²² The women randomly received a soy isoflavone extract (containing a total of 70 mg/d of genistein and daidzein) or placebo for four months. Women receiving the isoflavone extract had a 38-percent reduction in the mean number of hot flashes per day by the end of four weeks, a 51-percent reduction by the end of eight weeks and a 61-percent reduction after 16 weeks; hot flashes were reduced 21 percent in women receiving placebo after 16 weeks of supplementation. Another study by Italian researchers, however, found daily administration of 72 mg of soy-derived isoflavones was no more effective than placebo in reducing hot flashes in postmenopausal women.²³

In addition to helping with menopausal symptoms, soy may also improve cognitive function in postmenopausal women, according to researchers at Kings College London.²⁴ In a 12-week double blind, parallel study, 33 postmenopausal women were given either a soy isoflavone supplement (Solgen 40 from Ashdod, Israel-based Solbar) or placebo. After 12 weeks of supplementation, subjects receiving soy showed significantly greater improvement overall in episodic memory (picture recall, story recall and matching tests), frontal lobe function (mental flexibility and planning) and sustained attention tasks compared to the placebo group. And in a study conducted at the University of California, San Diego, isoflavone supplementation was found to have a favorable effect on cognitive functionparticularly verbal memoryin postmenopausal women.²⁵

Flaxseed also has phytoestrogenic properties and may help improve mild menopausal symptoms²⁶ During the cross-over study, subjects consumed 40 g/d of flaxseed (providing 21 mg of total lignans) for two months or received HRT for two months; after a two-month washout period, subjects were crossed-over and received the opposite treatment. After the 10-week study, researchers concluded flax, as well as HRT, successfully reduced mild menopausal symptoms, as well as lowered serum levels of glucose and insulin. Flax may also alleviate a form of premenstrual breast pain called cyclical mastalgia, according to research presented at the 23rd San Antonio Breast Cancer Symposium, held Dec. 6 to 9, 2000.²⁷

Long-term administration of low-dose dehydroepiandrosterone (DHEA, a hormone) may also reduce climacteric symptoms, according to researchers at the University of Modena, Italy.²⁹

Heart Disease

Heart disease was the no. 1 killer among both women and men in the year 2001, according to the Centers for Disease Control and Preventions (CDC) National Vital Statistics Report. The category of cardiovascular disease (CVD)which encompasses heart disease, stroke, congestive heart failure and high blood pressureclaimed the lives of more women (361,047) than men (339,095), which may be connected to womens lack of estrogen once they reach menopause. According to Johns Hopkins Health After 50, a health newsletter for people over 50, estrogen appears to protect the heart by keeping the arteries dilated, discouraging the formation of blood clots and preventing the buildup of artery-clogging plaque. Once a woman reaches menopause, her risk for developing CVD increases significantly because estrogen production is markedly reduced.

As previously noted, HRT was thought to help protect women against heart disease, but was found in studies to actually increase the risk of heart disease, stroke and breast cancer.³⁰ Fortunately, a wide variety of natural remedies are available to help women reduce the risk of heart disease.

The diverse category of antioxidants, which includes a variety of vitamins, minerals, flavonoids, carotenoids and botanical ingredients, are often used by women and men for their heart protecting abilities. Numerous studies have investigated this class of compounds for promoting heart health in women.

In one study of 423 postmenopausal women evaluating the effects of HRT and antioxidant vitaminsvitamin C and vitamin Eon atherosclerosis, researchers concluded neither treatment provided cardiovascular benefits to postmenopausal women with coronary heart disease (CHD).³¹ Instead, researchers suggested the two treatments, either administered alone or in combination, may cause more harm than good. Another study conducted at the University of Illinois, Chicago, also found HRT combined with vitamins C and E does not provide cardiovascular benefit for postmenopausal women with CHD.³²

Researchers at the University of Kuopio in Finland, however, reported supplementation of vitamin E and slow-release vitamin C may slow down atherosclerotic progression in hypercholesterolemic adults.³³ And a 16-year study of female nurses indicated women taking vitamin C supplements were at lower risk for heart disease compared to women who do not use vitamin C supplements or multivitamins.³⁴

Another antioxidant that may also help promote heart health is coenzyme Q10 (CoQ10), a vitamin-like nutrient with a proven track record for improving endothelial function in diabetic subjects with dyslipidemia,³⁵ and for increasing high density lipoprotein (HDL) cholesterol levels while decreasing low density lipoprotein (LDL) and total cholesterol levels.³⁶ A systematic review of CoQ10 in physical exercise, hypertension and heart failure suggests the antioxidant may help reduce blood pressure (BP) and improve symptoms in people with congestive heart failure.³⁷ CoQ10 supplementation was found to lower systolic BP and diastolic BP by 16 mm Hg and 10 mm Hg, respectively. As part of the review, the researchers conducted a randomized, double blind, placebocontrolled trial of CoQ10 in subjects with heart failure. They found supplementation with CoQ10 for three months significantly improved subjects symptom class and exercise time. A meta-analysis of nine randomized trials of CoQ10 in heart failure conducted by the same researchers, however, found non-significant trends toward reduced mortality with CoQ10 supplementation. They concluded the trials had insufficient numbers of subjects for meaningful results. Contrarily, a researcher at Copenhagen University Hospitals Heart Centre in Denmark reported several trials with CoQ10 supplementation and heart failure have reported statistically significant results and concluded based on the available controlled data, CoQ10 is a promising, effective and safe approach in chronic heart failure.³⁸ The same study also noted low levels of CoQ10 in myocardial tissue content have been detected in subjects with heart failure and the level of CoQ10 deficiency was correlated with the severity of heart failure. A study conducted at the Department of Veterans Affairs Medical Center in Boise, Idaho, also found CoQ10 beneficial in lowering BP. Researchers studied the effectiveness of an over-thecounter CoQ10 nutritional supplement in a cohort of 46 men and 37 women with isolated systolic hypertension.³⁹ After 12 weeks of daily administration of 120 mg of oral CoQ10, systolic BP was reduced by an average of 17.8 mm Hg. They concluded it may be safely offered to hypertensive patients as an alternative treatment option. The antioxidant also has been shown to improve BP in diabetics⁴⁰ and diabetics with dyslipidaemia.⁴¹

Also in the extended family of antioxidants are carotenoids, which may have heart health benefits for women as well. A 12-year study of 73,286 female nurses indicated higher intakes of foods rich in alphacarotene or beta-carotene are associated with a reduced risk of coronary artery disease.⁴² The researchers found no significant relation with intakes of lutein/zeaxanthin, lycopene or beta-cryptoxanthin, however. Contrarily, an animal study conducted at the University of Southern California, Los Angeles, found dietary intake of lutein, zeaxanthin, beta-cyptoxanthin and alpha-carotene may protect against development of atherosclerosis.⁴³ Higher plasma levels of lycopene are also associated with a lower risk of cardiovascular disease in women, according to a study of 39,876 women conducted by researchers at Brigham and Womens Hospital and Harvard Medical School, Boston.⁴⁴

Another member of the antioxidant family, flavonoids, are also thought to contribute overall to a healthy heart. For example, in a prospective cohort study of postmenopausal women, total flavonoid intake was associated with a decreased risk of coronary heart disease after adjusting for age and energy intake.⁴⁵ And in meta-analysis of prospective cohort studies, reduced mortality from heart disease was also associated with high dietary intake of flavonols, a class of flavonoids, from fruits, vegetables, tea and red wine.⁴⁶ The specific flavonoid transresveratrol, found commonly in the skins of grapes and other botanicals, may particularly contribute to heart health. Researchers from Creighton University School of Pharmacy suggest trans-resveratrol offers cardioprotection in postmenopausal women.⁴⁷ The trans-resveratrol used in the study was Protykin from InterHealth Nutraceuticals Inc. Flavonoids found in tea may also exhibit cardioprotective properties, according to researchers at the U.S. Department of Agricultures Agricultural Research Service Beltsville Human Nutrition Research Center in Beltsville, Md., who studied the effects of tea consumption on cholesterol levels in hypercholesterolemic subjects. They found five servings/d of tea for three weeks reduced total cholesterol by 6.5 percent and LDL cholesterol by 11.1 percent compared to placebo with added caffeine, and reduced total cholesterol by 3.8 percent and LDL cholesterol by 7.5 percent compared to placebo with no caffeine.⁴⁸ Researchers concluded because tea was found to lower total and LDL cholesterol, it may reduce coronary heart disease risk.

Soy and its isoflavones have been touted for numerous health benefits, particularly benefiting heart health in women. Studies have found soy protein with isoflavones favorably alters endothelial function,^49,50 reduces LDL degradation,⁵¹ and may reduce heart disease risk in postmenopausal women.⁵² Soy isoflavones, independent of the protein source, have also been shown to benefit female heart health.⁵³ In an animal model of postmenopausal hyperlipidemia, low (9.5 mg/kg diet), medium (19 mg/kg diet) and high (38 mg/kg diet) doses of soy isoflavones prevented a rise in plasma total cholesterol and the formation of atherosclerotic lesions. And in diabetic postmenopausal women, soy isflavones (as Solgen soy isoflavones from Solbar Plant Extracts) lowered mean values for blood components associated with diabetes and cardiovascular risk profile (i.e., fasting insulin, insulin resistance and total cholesterol) more so than soy protein or placebo.⁵⁴

Red clover isoflavones also exhibit positive effects on heart health in women. A study of healthy pre- and postmenopausal women conducted at Royal Free and University College London Medical School found red clover isoflavones exert positive effects on HDL cholesterol, but have a small effect on insulin-like growth factor (IGF) in premenopausal women and no effect on IGF in postmenopausal women.⁵⁵ And researchers from St. George Hospital UNSW, in Kogarah, Australia, found supplementation of red clover isoflavones favorably influenced BP and endothelial function in diabetic postmenopausal women.⁵⁶

Another plant that impacts heart health and cholesterol levels is flax. Flaxseed has been shown to improve lipid profiles in postmenopausal women.⁵⁷ However, a study conducted at Universite Laval in Quebec concluded 40 g/d of flaxseed is not as effective as HRT for improving cholesterol levels or cardiovascular health in menopausal women.⁵⁸ During the cross-over study, flaxseed supplementation (40 g/d for two months) lowered LDL cholesterol by approximately 1.6 percent, whereas HRT for 2 months lowered LDL cholesterol by approximately 16 percent, and total cholesterol/HDL cholesterol was reduced by 2 percent with flaxseed supplementation and by 14 percent with HRT.

Pycnogenol may also help reduce high blood pressure.⁵⁹ Researchers administered 100 mg of Pycnogenol to 33 men and 25 women with hypertension for 12 weeks. During supplementation, the subjects were able to significantly reduce their prescription BP medications.

Several vitamins and minerals may also play a role in womens heart health, including vitamin D, vitamin K and calcium. According to researchers from Clinic der Furstenhof, Bad Pyrmont, Germany, inadequate intake of vitamin D3 and calcium may contribute to the progression of hypertension and cardiovascular disease in elderly women.⁶⁰ They concluded short-term supplementation with vitamin D3 or calcium reduces systolic blood pressure, although a combination of the two nutrients had a more positive effect. In contrast, a study conducted at Saint-Joseph University in Beirut, Lebabon, found short-term supplementation of calcium and vitamin D3 did not improve lipid levels in postmenopausal women.⁶¹ A combination of vitamin D and K1, however, may be beneficial to improve elastic properties of the arterial vessel wall, according to research conducted at the University of Maastricht, The Netherlands.⁶²

Fish oil supplements, which contain essential fatty acids (EFAs), are also touted for their benefits to heart health. Results from a study conducted at the University of North Carolina at Greensboro suggest fish oil supplements may decrease the risk for cardiovascular disease in postmenopausal women by modulating plasma lipids and inflammatory markers.⁶³ Researchers at the Louisiana State Health Sciences Center, Kenner, also agree fish oil is beneficial to postmenopausal women, particularly by preventing secondary coronary artery disease.⁶⁴ And a review of the Nurses Health Study involving 84,688 women ages 34 to 59, found women who consumed high amounts of fish and omega-3 fatty acids had a lower risk of coronary heart disease.⁶⁵

Image: Women's Health Market

Cancer

Second only to heart disease, cancer takes the most lives of American women and men each year, according to CDCs National Vital Statistics Report. In 2001, cancer took the lives of 266,694 womenan improvement over the 267,009 women who died from the disease in 2000and 287,075 men. Although cancer affects men more than women, women are at much higher risk for breast cancer, as well as types of the disease that are specific to womenovarian, cervical and uterine (endometrial) cancer. According to the National Center for Health Statistics (NCHS), the number of female deaths from breast cancer reached 41,809 for the year 2001, and for women between the ages of 35 and 54, cancer (as a whole) was the leading cause of death.

The use of complementary and alternative medicine (CAM) has become widespread among healthy and unhealthy individuals alike, whether to supplement the diet, boost the immune system or for a general increase in health and well-being. And in the realm of cancer, use of CAM therapies combined with conventional therapy by female breast cancer survivors is particularly high, according to research from Western Oregon University, Monmouth.⁶⁶ Of the 551 women who had been diagnosed with breast cancer approximately 3.5 years earlier, researchers found two-thirds used at least one CAM therapy during the previous 12 months. Among the CAM practices used most often were herbs and megavitamins, which the women believed could help prevent cancer recurrence and/or improve their quality of life. Researchers from the University of Kansas Medical Center, Kansas City, agreed, stating many cancer patients combine some form of complementary and alternative medicine therapies with their conventional therapies.⁶⁷ They stated the most common form of CAM therapy was using antioxidants.

In a group of multivariate models among postmenopausal women with breast cancer, antioxidant supplement users were less likely to have breast cancer recurrence or breast cancer related death compared to non-users, according to researchers at the University of North Carolina, Chapel Hill.⁶⁸ They noted vitamin C and vitamin E supplements showed a modest protective effect when used for more than three years, but premorbid dietary intake from the diet and/or supplements showed no relationship with risk. Decreased antioxidant levels have also been shown in patients with breast cancer.⁶⁹ Researchers from the Institute of Cancer Epidemiology in Copenhagen, Denmark, however, found no evidence of an association between vitamin E or vitamin A and breast cancer in postmenopausal women, and found increased breast cancer rates among women with increased vitamin C intake.⁷⁰

When studying nutritional factors in relation to breast cancer risk among postmenopausal women in Mexico, intake of vitamin E and carotenoids was found to lower breast cancer risk, along with consumption of a low-fat diet and fiber.⁷¹ Researchers from Johns Hopkins University in Baltimore also report carotenoids may protect against breast cancer.⁷² They found the risk of developing breast cancer among women in the highest intake of beta-carotene and lycopene was almost half that of women with the lowest intake. Carotenoids may also be associated with a reduced risk of breast cancer in premenopausal females who smoke.⁷³ And in vitro research conducted at the Public Health College of Nanjing Medical University, Nanjing, China, showed beta-carotene and lycopene, as well as zeaxanthin and astaxanthin, exert anti-proliferate effects on human breast cancer cells.⁷⁴ And a casecontrolled study conducted by researchers at Johns Hopkins University involving 590 women found average concentrations of beta-carotene, lycopene, total carotene and lutein were significantly lower in women with breast cancer than those without.⁷⁵ Lutein has also been shown to inhibit mammary tumor growth in mice by selectively modulating apoptosis (programmed cell death).⁷⁶ Mice fed 0.002-percent lutein had higher apoptotic activity in breast tumors, but lower apoptotic activity in blood lymphocytes, compared to unsupplemented mice.

Vitamin E, which is made up of eight isomers, including four tocotrienols and four tocopherols, may also be beneficial in cancer prevention. A full spectrum vitamin E tocotrienol complex (as Tocomin palm tocotrienol complex supplied by Edison, N.J.-based Carotech Inc.) has been shown to inhibit growth of human breast cancer cells in vitro, according to researchers at the University of Western Ontario, London.⁷⁷

Lycopene has also been shown to reduce the risk of ovarian cancer,⁷⁸ as well as reduce mortality among subjects with secondary cancer of the oral cavity, pharynx or larynx.⁷⁹ Assessment of the Missouri Womens Health Study of 587 women with lung cancer and 624 healthy controls found carotenoids beneficial in reducing lung cancer incidence, although consumption of a wide variety of vegetables had a greater impact on lung cancer risk than intake of specific carotenoids or total carotenoid intake.⁸⁰

Researchers from the University of Hohenheim in Stuttgart, Germany, found concentration of all carotenoids, including alpha-carotene, betacarotene, lutein, lycopene, zeaxanthin and beta-cryptoxanthin, were reduced in colorectal adenomas,⁸¹ and a diet rich in lutein and zeaxanthin, as well as long-chain polyunsaturated fatty acids (LC-PUFAs), was recommended for French-Canadian females to help prevent colon cancer.⁸² A protective effect of vitamin C, vitamin E, beta-carotene and calcium was also found for colon cancer, according to a study conducted at the University of North Carolina, Chapel Hill.⁸³ The researchers reported intake of the micronutrients showed a 30-percent to 70-percent reduction in colon cancer risk.

The B vitamins have also been shown to help protect women against colon and ovarian cancer. Women with high folate, vitamin B6 and vitamin B12 intake were shown to have lower risk of colon cancer compared to women with a low intake, according to University of Minnesota researchers from Minneapolis.⁸⁴ Dietary intake of folate may also play a role in reducing ovarian cancer risk, particularly among women who drink alcohol, according to a study conducted at Karolinska Institutet in Stockholm, Sweden.⁸⁵ Researchers at the Department of Epidemiology and Surveillance Research, American Cancer Society in Atlanta, however, found no association with folate intake and breast cancer risk.⁸⁶

Vitamin D analogs have also been shown to inhibit the growth of breast cancer cells in vitro and in vivo,⁸⁷ and German researchers (from Universitatskiliniken des Saarlandes, Homburg/Saar, Germany) suggest vitamin D analogs should be considered as a potential preventive therapy or treatment for cervical carcinomas, breast cancer and ovarian cancer.⁸⁸ Researchers from the University of Illinois, Chicago, also found a vitamin D analog (1alpha hydroxy D5) may be a therapeutic treatment for Her-2 positive breast cancer.⁸⁹

Zinc may also have potential in treating ovarian cancer if administered as an adjuvant to chemotherapy, according to researchers at the Pomeranian Academy of Medicine, Szczecin, Poland.⁹⁰ Administration of 200 mg/d of selenium for three months (in addition to the drug Protecton Zellactiv from Smith Kline Beecham, Fink Naturarznei GmbH, Germany) resulted in a significant increase of white blood cells and a decrease of hair loss, flatulence, abdominal pain, weakness, malaise and loss of appetite. And researchers from Kyungpook National University, Daegu, Korea, found intake of dietary zinc was associated with a decreased risk of proximal and distal colon cancer in a cohort of 34,708 postmenopausal women.⁹¹

Lignans, found in high concentrations in flaxseed, have also been shown to help prevent^92,93 and treat breast cancer. In an animal model of breast cancer, flaxseed was shown to inhibit established breast cancer growth and metastasis.⁹⁴ Mice with established breast cancer were fed either a diet containing 10 percent flaxseed or a control diet for 15 weeks. At the end of the 15-week supplementation period, the mean tumor number of total and lymph node metastasis was significantly lower in mice fed flax compared to mice fed the control dietspecifically, the number of metastatic lung tumors was reduced by 82 percent. And according to research presented at the 23rd San Antonio Breast Cancer Symposium, held Dec. 6 to 9, 2000, flaxseed and its lignan components may reduce breast cancer tumor growth just as effectively as tamoxifen, a commonly used breast cancer treatment.⁹⁵

Soy and its isoflavones may also reduce the risk of breast cancer. In a study conducted by researchers in the Cancer Information and Epidemiology Division of the National Cancer Center Research Institute in Tokyo it was found that consumption of miso soup (made from soybeans) and isoflavones was inversely associated with breast cancer risk.⁹⁶ Individual isoflavonesgenistein in particularhave also been associated with reduced breast cancer risk. Researchers from the Hong Kong Polytechnic University in China found genistein significantly inhibited the growth of human breast cancer cells,⁹⁷ as did researchers at Wayne State University School of Medicine in Detroit, who found genistein induced breast cancer cell apoptosis.⁹⁸ Like flax, the phytoestrogen may also help reduce the risk of developing breast cancer later in life, according to researchers at Georgetown University in Washington.⁹⁹ Soy and its isoflavones may also help protect women from colon cancer, according to a study conducted at the University of Missouri, Columbia, Mo.¹⁰⁰

Osteoporosis

In addition to having an increased risk of heart disease and breast cancer, women also have a higher risk of developing osteoporosis. Of the 10 million Americans estimated to have osteoporosis, 80 percent are women, according to the National Osteoporosis Foundation (NOF). And one in two women over the age of 50 will have an osteoporosis-related fracture in her lifetime, compared to one in four men, according to NOF. Osteoporosis is manifested by porous bones and is characterized by low bone mass and structural deterioration of bone tissue that leads to fragility and an increased susceptibility to fractures, especially in the hip, spine and wrist.

Simple dietary interventions, such as consuming adequate amounts of fruits and vegetables¹⁰¹ as well as protein¹⁰² may be beneficial for maintaining optimal bone health. Two specific nutrients that are key for healthy bone maintenance and are recognized as complementary therapy for osteoporosis are calcium and vitamin D.¹⁰³ Research conducted at Garvan Institute of Medical Research, Darlinghurst, Australia, suggests supplementation of the two nutrients can reduce hip fractures, particularly in the elderly,¹⁰⁴ and researchers at the University of Michigan Medical Center, Ann Arbor, suggest calcium and vitamin D act synergistically to reduce fracture risk in men and women, and need to be taken together to impact fracture risk.¹⁰⁵ On its own, calcium has also been seen to protect against bone loss,¹⁰⁶ as well as when combined with calcitrol, a form of vitamin D.¹⁰⁷ And an 18-year prospective analysis of 72,337 postmenopausal women indicated vitamin D intake specifically lowered the risk of osteoporotic hip fractures.¹⁰⁸ Researchers at the Robert B. Brighton Arthritis and Musculoskeletal Clinical Research Center in Boston noted the protective effect of vitamin D on fractures has been attributed to vitamin D impacting bone mineral density (BMD) and calcium homeostasis.¹⁰⁹ They did, however, offer an alternative explanation to vitamin Ds bone benefits it may affect factors directly related to muscle strength, thus reducing fracture risk through improved function and fall prevention.

Vitamin K may also help women slow the progression of bone loss. Research conducted at the University of Maastricht, The Netherlands, concluded vitamin K1, if administered with a mineral-vitamin D supplement, may substantially reduce postmenopausal bone loss, particularly at the femoral neck.¹¹⁰ And results from an animal study suggest a diet rich in vitamin K2, vitamin D and calcium will suppress the rate of bone loss and prevent osteoporotic bone fractures.¹¹¹ The same study found peak bone mass can be raised by consuming sufficient amounts of the nutrients continuously from childhood. A combination of vitamin K2 and HRT may also improve bone mineral density better than HRT alone, according to researchers at Toyama Medical and Pharmaceutical University, Japan.¹¹²

One of the B vitamins, vitamin B12, is associated with bone health in older women, according to researchers at Wageningen University in The Netherlands.¹¹³ After investigating vitamin B12 levels in 143 elderly women, they noted osteoporosis was occurred more often in women with deficient vitamin B12 levels, compared to women with normal B12 status.

Antioxidants have also been studied for their ability to help maintain bone mineral content (BMC), BMD and reduce fractures. Researchers at the University of Perugia, Italy, noted antioxidant defenses are markedly reduced in osteoporotic women.¹¹⁴ In particular, vitamin C and vitamin E have been shown to reduce the risk of fracture in female smokers,¹¹⁵ and when given to osteoporotic rabbits together with sodium selenite, a type of selenium, bone tissue had almost the same structure as in normal rabbits, leading researchers to conclude the combination was more effective than the individual vitamins at preventing bone structure alterations.¹¹⁶ Researchers at the University of Cambridge, England, also noted low intake of vitamin C was associated with a faster rate of BMD loss in elderly adults.¹¹⁷

Phytoestrogens have also been studied in regard to improving womens bone health. According to a review of in vitro, in vivo, human observational and dietary intervention studies, diets rich in phytoestrogens have bone-sparing effects in the long term.¹¹⁸ Soy isoflavones, in particular, are thought to have beneficial effects, especially in postmenopausal women. A study of postmenopausal women conducted by researchers at the Chinese University of Hong Kong found women who consumed 80 mg/d of soy isoflavones combined with 500 mg/d of calcium and 125 IU/d of vitamin D3 exhibited a higher change rate of hip BMC compared with women who consumed 40 mg/d of isoflavones or placebo and the same amounts of calcium and vitamin D3.¹¹⁹ Researchers concluded soy isoflavones may help maintain BMC in postmenopausal women with low initial bone mass. And postmenopausal women supplemented with a multi-ingredient food supplement containing soy isoflavones (as Solgen 40, from Solbar) had increased bone strength, according to an unpublished study conducted at Hospital Gailezers in Riga, Latvia.

A specific soy isoflavone, genistein, may prevent cadmium-induced bone loss in an animal model of menopause, according to researchers at Hanyang University in Seoul, Korea,¹²⁰ and a double blind, placebocontrolled study conducted at the University of Messina, Italy, found genistein had positive effects on bone loss in postmenopausal women by increasing bone formation.¹²¹

Intake of soy protein with isoflavones has been shown to have a modest but significant association with hip BMD and total body BMC in postmenopausal women, according to researchers at the Chinese University of Hong Kong.¹²² Researchers estimated dietary intake of soy protein and isoflavones in a cohort of 454 healthy Chinese postmenopausal women and categorized intake by quartile. They found few differences in BMD and BMC among the intake quartiles in women within the first four years of menopause. However, among women in the later years of menopause, the researchers noted a dose-response relationship between higher BMD values and increasing quartiles of soy protein intake.

Today, more female consumers are turning to natural remedies, in addition to more traditional forms of medicine. Whether women want relief from PMS or hot flashes, or want to help protect their heart and bones from the deleterious effects of menopause, their choices of CAM therapies are vast.

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