May 26, 2003
by Kim Schoenhals
Once considered fragile, insipid creatures, women have foughtlong and hard for equal rights in America and over the decades have earned theright to vote, a strong presence in the workforce and an increased enrollment inthe U.S. military. In 1984, American women earned another significant gain interms of equality--that is the year women surpassed men in the number of annualdeaths from heart disease.
In addition to heart disease, breast cancer and osteoporosis arestatistically more of a threat to women than men. Other conditions affectingwomen specifically have their basis in hormone balance and include premenstrualsyndrome (PMS), premenstrual dysphoric disorder (PMDD) and menopause.
Traditional medicine has offered several therapies for heartdisease, cancer, osteoporosis and hormone-related conditions. However, a blow towomen's faith in traditional medicine was delivered in July 2002 when theNational Institutes of Health (NIH) halted an arm of its eight-year hormonereplacement therapy (HRT) study after five years due to unacceptable increasesin the risk of breast cancer and heart disease.1
Prior to this trial, and continuing today, millions of womenhave used HRT to combat the side effects of decreased estrogen production.Menopausal women are more likely to suffer heart disease and osteoporosis, aswell as to develop symptoms such as insomnia, memory loss and hot flashes.
Since NIH halted its trial, women have increasingly turned toalternative medicine in the hopes of reducing the risk of chronic disease, aswell as for relief from menopause. The North American Menopause Society (NAMS)recommends several alternative therapies for women who do not want to use HRT.Specifically, they advise women to eat well and get plenty of exercise, but theyalso mention using soy foods and black cohosh to reduce the occurrence of hotflashes, and vitamin D and calcium to improve bone health.
According to the Natural Marketing Institute's (NMI) Health& Wellness Trends Database, women are most likely to use supplements forbone health, with 62.3 percent of women surveyed reporting they would usesupplements to self-treat osteoporosis. NMI also noted 50.2 percent of womenwould use supplements to treat cancer, 47.2 percent for menopausal issues, and51.3 percent cited a willingness to use supplements for heart disease.
Nearly 50 percent of all female deaths are caused by heartdisease. According to the Centers for Disease Control and Prevention's (CDC) NationalVital Statistics Report, heart disease was the No. 1 killer among both menand women in the year 2000, although women still held the top spot with 365,953succumbing to heart disease compared to 344,804 men.
The category of cardiovascular diseases encompasses coronaryheart disease, stroke, congestive heart failure and high blood pressure. About6.6 million women alive today have a history of heart attack, angina pectoris(chest pain caused by reduced blood supply to the heart) or both, according tothe American Heart Association (AHA). AHA also reports heart disease rates aretwo to three times greater in women who have reached menopause compared to womenof the same age before menopause.
Probably one of the more common complementary therapies forreducing the risk of heart disease is a regimen of antioxidants. Thereare several different types of antioxidants, ranging from vitamins and mineralsto carotenoids, flavonoids and botanicals. The research on many of these ispromising for protecting heart health, although not all results have beenpositive.
A study of antioxidant vitamins in combination with HRT forreducing the risk of coronary atherosclerosis in women was concluded withoutpromising results.2 Researchers at San Francisco General Hospitalrandomly assigned 423 postmenopausal women with coronary heart disease toreceive either HRT or matching placebo, and 400 IU of vitamin E plus 500mg of vitamin C twice daily or placebo. Results indicated while there wasno interaction between the treatments, neither HRT nor antioxidant vitaminsprovided a cardiovascular benefit. A trial out of the University of Illinois,Chicago, ended similarly, with researchers concluding HRT combined with vitaminsC and E does not specifically benefit cardiovascular health in postmenopausalwomen with coronary heart disease.3
Contrarily, a six-year study of vitamins C and E indicated thecombination effectively slowed the progression of atherosclerosis.4Researchers initially enrolled 520 smoking and nonsmoking men and postmenopausalwomen--440 of whom completed the study--to take 136 IU of vitamin E plus 250 mgof slow-release vitamin C twice daily for six years. Researchers concluded thecombination slowed atherosclerotic progression in subjects with highcholesterol.
Another antioxidant that is important in the realm of hearthealth is coenzyme Q10 (CoQ10), a vitamin-like nutrient known for itsrole in promoting cellular energy production in the body's mitochondria.Mitochondrial function may be supported by CoQ10 administration and is ofparticular importance during and after heart surgery, according to researchersat the Alfred Hospital and Baker Institute in Australia.5 CoQ10 mayalso be useful as an adjuvant treatment for chronic heart failure, according toa review out of the Medical College of Virginia in Richmond.6Researchers at the Department of Veterans Affairs Medical Center in Boise,Idaho, stated CoQ10 is a safe treatment option for hypertensive patients.7CoQ10 supplementation is also important for patients taking statin drugs forhigh cholesterol levels, because the drugs are known to deplete the body of itsCoQ10 stores.8
A group of antioxidants known as carotenoids, which arefat-soluble pigments found in plants, may also have something to do with howwell heart health is maintained. Two carotenoids, lutein and lycopene,have been studied for their effects on heart health. An animal study conductedat the University of Southern California, Los Angeles, demonstrated increaseddietary intake of lutein protected against the development of atherosclerosis.9As for lycopene, it was shown to decrease the risk of cardiovascular diseasespecifically in women, as noted in a presentation given by researchers fromBoston's Harvard Medical School at the 2002 annual meeting of the AmericanCollege of Cardiology.10
Like carotenoids, flavonoids are plant pigments withantioxidant properties that may contribute to their ability to improveparameters of heart health. In particular, grapeseed extract promotescardiovascular health in various ways, according to researchers at CreightonUniversity in Omaha, Neb., who conducted in vitro, animal and human research.11A research review of grapeseed extract (as MegaNatural Gold, manufactured byMadera, Calif.-based Polyphenolics) indicated oral intake decreased plasma totaland LDL cholesterol in subjects with high cholesterol, although HDL cholesterolwas also decreased.12
Soy isoflavones have also been proven to benefit hearthealth--particularly in women. Researchers at the University of Hull and HullRoyal Infirmary in England found that of 32 postmenopausal women with Type IIdiabetes, those assigned to take phytoestrogens (30 g/d of soy protein, 132 mg/dof isoflavones) exhibited reductions in mean values for total and LDLcholesterol, as well as decreased values for fasting insulin and insulinresistance.13 Another study showed phytoestrogen intake reduced therisk of atherosclerosis and arterial degeneration in menopausal women.14
Red clover isoflavones have also been shown to helpmaintain heart health in menopausal women. Researchers from the Institute ofGynecology and Reproduction in Lima, Peru, randomly assigned 100hypercholesterolemic, menopausal women to take either a red clover isoflavoneformula (as Promensil, manufactured by Stamford, Conn.-based Novogen Ltd.) orplacebo.15 Women in the treatment group maintained cholesterol levelsmore effectively than women in the placebo group, leading researchers toconclude long-term use of the supplement would help women maintain healthycholesterol levels.
Another plant that impacts cholesterol levels is Commiphoramukul, commonly known as guggul. The heart-healing constituents of guggulare its guggulsterones and guggulsterols, which are believed to contribute tohealthy cholesterol levels. Researchers at Baylor College of Medicine in Houstondetermined the mechanism of action behind guggul's activity is its inhibition ofthe FXR receptor, which is a hormone receptor activated by bile acidsresponsible for cholesterol homeostasis.16 Some of the sameresearchers determined guggulsterone E and guggulsterone Z are responsible forthe extract's lipid-lowering activity.17 In the United States,Piscataway, N.J.-based Sabinsa Corp. holds U.S. patent No. 6,436,991 coveringits guggul extract (Gugulipid) for the prevention and treatment ofcardiovascular disease.
Like guggul, flaxseed is known for lowering cholesterollevels. Research out of Oklahoma State University in Stillwater demonstratedthis effect in postmenopausal women, with those taking ground flaxseed (40 g/d)for three months exhibiting a 4.7-percent reduction in both LDL and HDLcholesterol, and a 12.8-percent reduction in triglycerides.18Contrarily, a study out of Universite Laval in Quebec indicated 40 g/d offlaxseed did not improve cholesterol profiles in 25 menopausal women with highcholesterol compared to HRT.19
A botanical extract of French maritime pine bark also hasbeen shown to contribute to heart health. Researchers at the University ofCalifornia, Davis, found that of 25 healthy subjects assigned to receive theextract (150 mg/d of Pycnogenol, available from Hillside, N.J.-based NaturalHealth Science) or placebo for six weeks, those in the treatment group exhibitedincreased plasma antioxidant activity and HDL cholesterol levels, as well asreduced LDL cholesterol levels.20 Research out of the University ofArizona, Tucson, indicated pine bark extract (200 mg/d of Pycnogenol) decreasedsystolic blood pressure in 11 hypertensive patients after eight weeks ofsupplementation.21 Another study of pine bark extract, which has beenaccepted for publication in Life Sciences, demonstrated that of 58 hypertensivepatients, those taking 100 mg/d of the extract (as Pycnogenol) for 12 weeksrequired smaller doses of nifedipine to attain reductions in blood pressure.22
A mineral that may improve heart health in older women is calcium.Researchers in New Zealand enrolled 223 postmenopausal women (average age of 72)in a randomized, placebo-controlled trial of calcium citrate (1 g/d) andfound that after one year, women taking the mineral exhibited an average7-percent increase in HDL cholesterol.23
Popularly believed to reduce the risk of heart disease, Bvitamins have been reviewed numerous times for their potential role in hearthealth. Researchers analyzing the Nurses' Health Study, a cohort of 75,521women, found that while B vitamin intake did not fully explain the reduction inheart disease risk, B vitamin fortified whole grain intake reduced the women'srisk of heart disease.24 A review of 1,419 men and 1,531 women,however, failed to show folic acid or vitamin B12 specificallyreduced the risk of fatal cardiovascular disease.25
Another vitamin, vitamin D, may protect women againstcoronary heart disease, according to researchers at the University ofCalifornia, San Francisco, who reviewed data for 9,704 ambulatory women abovethe age of 65 who participated in the Study of Osteoporotic Fractures.26The researchers concluded vitamin D supplements in particular decreased the riskof heart disease mortality.
Essential fatty acids (EFAs) are also well-known fortheir benefits in heart health. The omega-3s in particular, from both marine andplant sources, are protective for individuals at risk of heart disease,according to researchers from the AHA Nutrition Committee.27Specifically in women, fish and omega-3 intake has proven protective, accordingto a review of the Nurses' Health Study.28 The review demonstratedthat of 84,688 women ages 34 to 59 years old, those who ate fish five or moretimes per week were less likely to die of heart disease than women who rarelyate fish. In addition, women with the highest intakes of omega-3 fatty acidswere less likely to die of coronary heart disease than women with lower intakes,and they had a decreased risk of non-fatal myocardial infarction, as well.
Cancer is the No. 2 killer in America, although it is moredeadly to men than women, according to CDC, which noted 286,082 men and 267,009women died of cancer in 2000. While cancer generally affects men more often thanwomen, breast cancer is much more prevalent among the fairer sex, and ovarian,cervical and uterine cancers are specific to women.
Breast cancer does affect men, although it is much more commonin women. An estimated 211,300 new cases of invasive breast cancer will bediagnosed in 2003, according to the Susan G. Komen Breast Cancer Foundation, andthe disease will take the lives of approximately 39,800 women and 400 men.
The female-specific cancers are less prevalent than breastcancer, but no less worrisome. Among U.S. women, ovarian cancer is the sixthmost common cancer and the fifth most likely to result in death, according tothe American Cancer Society (ACS). ACS estimates 25,400 new cases of ovariancancer will be diagnosed in the United States in 2003, and about 14,300 womenwill die of it.
Cervical cancer is much less deadly now than it was, accordingto ACS, and mortality rates for this type of cancer went down by 74 percentbetween 1955 and 1992. The reason is mainly due to an increase in the practiceof Pap tests, which can detect pre-cancerous changes on the cervix. Theseabnormal cells, if treated, will usually not develop into cancer, althoughaccording to ACS estimates, about 12,200 new cases of invasive cervical cancerwill be diagnosed in the United States in 2003, with approximately 4,100 womendying from it.
Uterine cancer can be grouped into three categories, dependingfrom which type of cell it develops. Approximately 40,100 American women will bediagnosed with some form of uterine cancer in 2003, according to ACS, and anestimated 6,800 women will die of it.
There are countless traditional methods for dealing with cancer,including radiation, chemotherapy and surgery, although supplements may be aneffective adjuvant treatment. "[M]any cancer patients combine some form ofcomplementary and alternative medicine therapies with their conventionaltherapies," according to researchers at the University of Kansas MedicalCenter in Kansas City. "The most common choice of these therapies is theuse of antioxidants."29 The same researchers published acase study of two patients with ovarian cancer and noted antioxidants appearedto be safe and effective when combined with traditional therapy.30
In addition to the increased need for antioxidants because ofheightened free radical production from chemotherapy, antioxidants may also beneeded to correct deficiencies that can occur in response to the body's internalfight against cancer cells. Increased lipid peroxidation and decreasedantioxidant levels are common in patients with breast cancer31 andcervical cancer.32 Specifically, vitamin C and vitamin E arefound in low levels in cervical cancer patients, perhaps because they depletethemselves by scavenging lipid peroxides, according to researchers in India.33
Vitamin E, which is made up of eight isomers including four tocopherolsand four tocotrienols, may also be protective in breast cancer.Tocotrienols (as Tocomin palm tocotrienol complex supplied by Edison,N.J.-based Carotech Inc.) have been shown to inhibit the growth of human breastcancer cells in vitro, according to researchers from the University of WesternOntario, Canada.34 They also showed that the palm tocotrienol complexworked synergistically with tamoxifen to inhibit breast cancer cells, and theeffect was 45-times higher with the combination than with either compound usedalone. Additional in vitro research out of the University of Reading in Englanddemonstrated individual tocotrienol isomers inhibited human breast cancer cellgrowth irrespective of estrogen receptor status.35
In ovarian cancer, vitamins C and E were found to be protective,according to a study out of the University of North Carolina, Chapel Hill.36Researchers in Italy found an inverse relationship between vitamins C and E, aswell as beta-carotene, and the incidence of breast cancer, leading themto conclude consumption of nutrient-rich fruits and vegetables had a protectiveeffect.37 A team at Harvard Medical School, however, did not find asignificantly protective effect against ovarian cancer from the consumption ofantioxidants from supplements or food.38
A team of Italian researchers found an inverse associationbetween intake of selected micronutrients--prevalent in fruits andvegetables--and ovarian cancer.39 Their study indicated vitamin E, aswell as the carotenoids beta-carotene, lutein and zeaxanthin, andthe mineral calcium, were protective against ovarian cancer.
While some research on carotenoids and cancer has failed todemonstrate a protective effect--such as a case-cohort analysis of 56,837 womenthat did not indicate carotenoid intake led to a reduced risk of breast cancer40--muchof the research has been positive. In vitro research with human breast cancercells showed an anti-proliferation effect with beta-carotene and lycopene,as well as zeaxanthin and astaxanthin.41
Human research has also shown a protective effect against breastcancer with carotenoid intake, according to a case-control study out of theJohns Hopkins University in Baltimore, Md., involving 590 women.42Researchers noted median concentrations of beta-carotene, lycopene, totalcarotene and lutein were significantly lower in cases than controls.
Lycopene has been specifically indicated in reducing the risk ofbreast cancer. Researchers from Ben-Gurion University in Be'er Sheva, Israel,found lycopene is more effective at preventing breast cancer when it is combinedwith other tomato phytonutrients. Their unpublished in vitro researchdemonstrated a complex of tomato phytonutrients (as Lyc-O-Mato, manufacturedby New York-based Lycored/Biodar) dramatically decreased cell proliferation in aline of breast cancer cells.
Beta-carotene intake may also be linked to reduced breast cancerrisk, as serum levels of beta-carotene are inversely associated with risk forthe disease.43 In addition, high intakes of beta-carotene wereassociated with a 16-percent decrease in the risk of ovarian cancer, accordingto a meta-analysis out of the Marshfield Clinic Cancer Center in Wisconsin.44However, beta-carotene may not protect against cervical cancer because it wasineffective for reducing the risk of cervical abnormalities, according toresearchers at the University of California, Irvine.45
Conversely, alpha-carotene, beta-cryptoxanthin andlutein/zeaxanthin may protect against cervical cancer by reducing the risk ofcervical lesions, according to researchers at the University of Washington,Seattle.46
Indole-3-carbinol (I3C), a constituent of cruciferousvegetables, is also suspected to promote the regression of cervical lesions,thereby reducing the risk of cervical cancer. Researchers at Louisiana StateUniversity in Shreveport randomly assigned 30 patients with cervical lesions totake either placebo or 200 mg/d or 400 mg/d of I3C (provided by Orem, Utah-basedDesigned Nutritional Products, which holds a patent for I3C in alleviatingsymptoms of fibromyalgia and received in May patents for applications with PMSand menopause).47 After 12 weeks, none of the patients in the placebogroup had complete regression, while four of eight patients in the 200 mg/dgroup and four of nine patients in the 400 mg/d group had complete regression.
The lignan-containing flaxseed may reduce the risk ofbreast cancer by increasing hormone metabolism, according to researchers at theUniversity of Minnesota, St. Paul.48 For three seven-week periods, 28postmenopausal women received 0 g/d, 5 g/d and 10 g/d of ground flaxseed inaddition to their habitual diets. Analysis of serum samples indicated theflaxseed diets significantly reduced serum concentrations of 17 beta-estradioland estrone sulfate, indicating an influence in endogenous hormone metabolism.
Like flaxseed, soy and its isoflavones may reduce therisk of breast cancer through altering hormone metabolism. A higher intake ofsoyfoods can reduce levels of estrone--a particular estrogen that is known toincrease the risk of breast cancer among postmenopausal women--according toresearchers at the Keck School of Medicine at the University of SouthernCalifornia, Los Angeles.49 The same researchers found a high intakeof soy during adolescence also reduces the risk of breast cancer, and additionalsoy intake during adulthood may also lower this risk.50 A similarstudy conducted at the Vanderbilt University School of Medicine in Nashville,Tenn., demonstrated a reduced risk of breast cancer with adolescent soyfoodintake.51 Soy intake may also reduce the occurrence of high-riskmammographic parenchymal patterns, predictors in breast cancer development.52
Animal research of soy supplementation has also shown a riskreduction with intake. Researchers at Creighton University School of Medicine inOmaha, Neb., studied the effect of supplementation with isolated soy protein onbreast cancer risk.53 They found that with soy supplementation, micehad a significant reduction in the number of detectable tumors compared to thecontrol group.
Black cohosh, an herb studied widely for its role inreducing menopause symptoms, may be useful for reducing breast cancer risk.Research out of the University of Illinois in Chicago indicated black cohosh hasfree radical scavenging ability and protected against cellular DNA damage in aline of breast cancer cells.54 An unpublished, company-sponsored, invitro study indicated a proprietary blend of black cohosh (as Menophase,available from Wayne, N.J.-based Triarco Industries) had no effect on eitheralpha or beta estrogen receptors, perhaps lending it to the prevention of breastcancer. The research also indicated the ingredient may be useful for inhibitingthe activity of aromatase, an enzyme that plays a role in the conversion ofestrogen to estradiol, thereby reducing estrogen circulation in both normal andmalignant breast tissue.
Osteoporosis, like breast cancer and heart disease, affects bothmen and women, but is more prevalent among women. According to the NationalOsteoporosis Foundation (NOF), of the 10 million Americans estimated to haveosteoporosis, 80 percent are women. Porous bones are the manifestation ofosteoporosis, which is characterized by low bone mass and structuraldeterioration of bone tissue that leads to fragility and a susceptibility tofractures.
One of the more commonly recognized complementary therapies forosteoporosis is the use of calcium and vitamin D supplements.Research has shown calcium and vitamin D are important for bone maintenance andsupplementation can both reduce the risk of osteoporosis and improve bone healthin those with the condition.55,56 Calcium and vitamin D are alsospecifically noted to reduce the rate of menopause-related bone loss, as well asdecrease the risk of fractures in postmenopausal women.57 An 18-yearprospective analysis of 72,337 postmenopausal women indicated vitamin D intakespecifically lowered the risk of osteoporotic hip fractures.58Calcium and vitamin D are also known for their excellent safety profile,according to researchers from the University of Michigan, Ann Arbor.59
The two nutrients improved musculoskeletal function anddecreased falls in 122 elderly women who were randomly assigned to take 1,200mg/d of calcium plus 800 IU/d of vitamin D (as cholecalciferol) or calcium alonefor 12 weeks.60 The intervention with vitamin D plus calcium reducedthe risk of falls by 49 percent compared to calcium alone, according toresearchers from the University of Basel, Switzerland.
Aside from calcium and vitamin D, several other vitamins andminerals are needed for maintaining and improving bone health. A study of 136healthy postmenopausal women out of the University of Connecticut, Storrs,demonstrated magnesium, zinc and vitamin C weresignificantly related to bone mineral density.61
Magnesium is required for several facets of bone health,including strength, preservation and remodeling.62 An animal studyconducted at the University of Southern California, Los Angeles, demonstratedthe necessity of magnesium in bone formation, with magnesium-depleted miceexhibiting a significant decrease in skeletal magnesium concentrations.63
Vitamin C, an antioxidant, is known for its contributionto collagen formation, and has also been shown to affect bone mineral density,according to researchers from the University of Perugia in Italy.64They evaluated blood and plasma samples from 75 osteoporotic and 75 healthywomen and found mean plasma levels of vitamin C, vitamin E and vitaminA were consistently lower in osteoporotic women compared to controls.
Vitamin A has been a slightly controversial nutrient in therealm of bone health research. In reviewing the Nurses' Health Study, a cohortof 72,337 postmenopausal women aged 34 to 77 years old, investigators fromBrigham and Women's Hospital and Harvard Medical School determined long-termintake of a diet high in retinol may promote the development of osteoporotic hipfractures in women.65 Researchers identified 603 incident hipfractures resulting from low or moderate trauma between 1980 and 1998, withwomen in the highest quintile of vitamin A intake (3,000 mcg/d of retinolequivalents) at a significantly higher risk compared to women in the lowestquintile of intake. Researchers attributed increased risk primarily to retinolintake, as beta-carotene did not contribute to serum retinolconcentrations and was not associated with an increased risk of fracture.
Vitamin K is necessary for bone health in general, thoughit may have particular application for women. A review of the Framingham HeartStudy conducted out of Tufts University in Boston indicated that of 1,479 women,those with the lowest intakes of vitamin K had significantly lower mean bonemineral density at the femoral neck and spine than women with the highestintakes.66 Researchers concluded this finding supported previousresearch indicating low vitamin K intake is associated with an increased risk ofhip fracture.
One of the B vitamins, vitamin B12, may have a link tobone mineral content status in women, according to researchers at WageningenUniversity in The Netherlands.67 They investigated vitamin B12 levelsin 143 elderly women and noted osteoporosis occurred more often among the womenwith deficient vitamin B12 levels than among women with normal status. This sameoccurrence was not noted in the 51 men who participated in the study.
Soy and its isoflavones have been widely studied inregard to improving women's bone health. A randomized, double blind,placebo-controlled study conducted at the University of Messina in Italyindicated the soy isoflavone genistein had positive effects on bone lossand increased bone formation in postmenopausal women.68
Soy protein with isoflavones has also been shown to attenuatebone loss in perimenopausal women, as noted by researchers at Iowa StateUniversity, Ames.69 They randomly assigned 69 perimenopausal women toreceive either soy protein rich in isoflavones or depleted of them, or wheyprotein (control) for 24 weeks. At the end of the study period, the percentagechange in lumbar spine bone mineral density and bone mineral content did notchange in either soy group, although there was a loss in the control group.Researchers also noted the isoflavone-rich diet had a positive effect on bonemineral density. (The soy protein for this study was provided by the St.Louis-based Solae Co.)
Researchers at Baylor College of Medicine in Houston arecurrently conducting the Osteoporosis Prevention Using Soy (OPUS) study, arandomized, double blind, placebo-controlled trial that will determine thebone-protective effects of soy isoflavones (as SoyLife, provided byMinneapolis-based Acatris Inc.) in a group of 400 postmenopausal women. Thewomen will be divided into one of three study groups--80 mg/d of isoflavones,120 mg/d of isoflavones or placebo--and all women will also be given 600 mg/d ofcalcium and 400 IU/d of vitamin D. The $4.5 million study is scheduled forcompletion before the end of 2004.
Ipriflavone, the synthetic form of soy isoflavones, hasalso been studied in regard to women's health after menopause. A recent reportout of the Center for Clinical and Basic Research in Bellerup, Denmark,indicated 200 mg of ipriflavone three times daily did not prevent bone loss oraffect biochemical markers of bone metabolism.70 In opposition tothis finding, researchers from the University of Michigan, Ann Arbor, noted in aresearch review that ipriflavone does have some effect on decreasing boneturnover and maintaining bone mineral density.71
Premenstrual syndrome (PMS) and its more severe cousin,premenstrual dysphoric disorder (PMDD), as well as menopause are all rooted in awoman's hormone levels. All three conditions are known for the bothersomesymptoms they cause, both physical and emotional. While PMS, PMDD and menopauseare not diseases to be cured, the symptoms that accompany them can be eased withtraditional and alternative medicine.
As many as 75 percent of menstruating women suffer from PMS,according to MayoClinic.com, and exhibit symptoms such as weight gain andbloating, breast tenderness, and mood swings caused partially by cyclic changesin hormones. Approximately 30 percent to 40 percent of women have symptoms thatare severe enough to affect their daily lives, and about 7 percent have thepsychologically disabling form of PMS known as PMDD. The troubles associatedwith PMS and PMDD may end with menopause, although this phase of a woman's lifebrings with it a new set of symptoms.
Menopause is defined by the North American Menopause Society (NAMS)as the point after 12 months of amenorrhea (absence of menstruation) when thereis a near complete diminution of ovarian hormone secretion. Approximately 1.35million American women reached natural menopause in the year 2000, bringing theestimated total number of postmenopausal women in the United States to nearly 40million.
Several minerals and vitamins are thought to contribute tofemale health and ease hormone-related symptoms. Calcium, for example,has been featured in the realm of easing the symptoms of PMS and possibly evenPMDD. Research out of St. Luke's-Roosevelt Hospital Center in New York indicatedPMS may represent a clinical manifestation of calcium deficiency,72and two research reviews indicated calcium has shown promise in clinicalsettings as a treatment for PMS.73,74 A review conducted at DalhousieUniversity in Halifax, Canada, suggested calcium carbonate be recommendedas a first-line therapy to women with mild to moderate PMS.75
MayoClinic.com has recommended PMS sufferers consider usingcalcium, as well as magnesium and vitamin E, to improve symptomsof PMS. Researchers at New Orleans' LSU School of Medicine noted clinicalevidence supports the use of all three nutrients in alleviating symptoms of PMS.76Independently, magnesium (200 mg/d) was shown in a double blind,placebo-controlled trial at England's University of Reading to reduce fluidretention caused by PMS.77
In addition to relieving PMS symptoms, vitamin E may reduce theincidence of hot flashes in postmenopausal women, according to researchers atthe Mayo Clinic in Rochester, Minn.78 They suggested for mildmenopausal hot flashes that do not interfere with sleep or daily function,vitamin E is a reasonable initial treatment option. Contrarily, a researchreview conducted at Columbia University College of Physicians and Surgeons inWashington, D.C., concluded vitamin E does not affect hot flashes.79
Researchers at the LSU School of Medicine also conducted adouble blind trial with magnesium and vitamin B6, learning that 200 mg/dof magnesium combined with 50 mg/d of vitamin B6 reduced anxiety-related PMSsymptoms such as nervous tension, mood swings and irritability.80However, MayoClinic.com warns women against using vitamin B6, saying,"Studies of daily supplementation with vitamin B6 failed to show itseffectiveness. High daily doses may cause nerve damage and are considereddangerous."
Aside from vitamins and minerals, several botanical andplant-derived ingredients are thought to offer assistance in alleviating thesymptoms that occur as a result of a woman's hormone fluctuations. Anantioxidant extract of French maritime pine bark is thought to reducepain associated with menstruation, and a U.S. patent was awarded for this use toPycnogenol. In research out of Kanazawa University in Japan, the extract (asPycnogenol) induced a 77-percent reduction in menstrual pain caused bydysmenorrhea (lower abdominal and pelvic pain that occurs during menstruation)when it occurred as a symptom of endometriosis (a chronic overgrowth ofmisplaced tissue that responds to a woman's menstrual cycle, causing pain andinflammation).81
Several other herbal remedies may alleviate PMS symptoms, asnoted by MayoClinic.com. Among those listed were black cohosh, ginger,red raspberry leaf, dandelion tea, chaste tree berry and eveningprimrose oil. An analysis of 33 trials for PMS conducted at ColumbiaUniversity in New York indicated chaste tree berry extract shows promise fortreating the symptoms of PMS.82 A research review out of Cedars-SinaiIntegrative Medicine Medical Group in Los Angeles suggested chaste tree berry, dongquai and evening primrose oil may be reasonable alternative therapies forPMS symptoms.83
The Cedars-Sinai researchers also noted dong quai and blackcohosh are safe for treating menopausal symptoms, although they stated onlyblack cohosh has proven effective. Researchers at Schaper & Brummer GmbH& Co. KG in Salzgitter, Germany, found black cohosh eased menopausalsymptoms without the side effects that can occur with HRT.84 Theyrandomly assigned women to either the standard dose (39 mg/d) or a high dose(127.3 mg/d) of black cohosh (as Remifemin, marketed in the United States byGlaxoSmithKline Consumer Healthcare) for 24 weeks in a parallel group study ofabout 150 peri- and postmenopausal women. Results did not demonstrate additionalbenefit with the higher dose, leading researchers to conclude a standard dose iseffective for reducing the physical and emotional symptoms of menopause.
Another herb, Polygonum cuspidatum (P. cuspidatum),is known to have estrogenic effects, which is one reason it is consideredpotentially effective for postmenopausal health. P. cuspidatum, the activeconstituent being trans-resveratrol, was studied by researchers at CreightonUniversity School of Pharmacy in Omaha, Neb. While their animal research focusedon the cardioprotective properties of P. cuspidatum (as Protykin, manufacturedby Benicia, Calif.-based InterHealth Nutraceuticals Inc.), they concluded theherb improves postmenopausal symptoms such as hot flashes, mood swings, vaginalitching and dryness, skin wrinkling, and bone strength.85
Red clover is another herb with phytoestrogen propertiesand has been suggested to reduce menopausal symptoms. Research out of TheNetherlands indicated red clover isoflavones may reduce the severity andoccurrence of hot flashes in postmenopausal women.86 After receivingplacebo for four weeks, 30 postmenopausal women were randomly assigned toreceive either 80 mg/d of red clover isoflavones (as Promensil, marketed byStamford, Conn.-based Novogen Ltd.) or placebo for another 12 weeks. Researchersnoted a 16-percent decrease in the frequency of hot flashes during the initialfour-week placebo period. However, during the double blind phase of the study,the isoflavone group exhibited a 44-percent decrease in the occurrence of hotflashes, while no further reduction was noted in the placebo group.
Red clover may also reduce symptoms associated with PMS, such asbreast pain that occurs as a result of the menstrual cycle. In a double blindstudy, the majority of women receiving 50 mg/d or 80 mg/d of a red cloverisoflavone supplement (as Promensil) showed greater than a 25-percent decline inself-reported breast pain.87
Like red clover, soy and its isoflavones are thought tohave numerous benefits in reducing the symptoms of hormone fluctuations inmenopause--specifically for hot flashes. A study of 75 menopausal womenconducted at Hospital Edouard Herriot in Lyon, France, indicated women taking asoy isoflavone extract (containing a total of 70 mg/d of genistein and daidzein)had a 38-percent reduction in the mean number of hot flashes after four weeks, a51-percent reduction after eight weeks, and a 61-percent reduction after 16weeks, compared to a 21-percent reduction in the placebo group after 16 weeks.88Researchers at the University of Ferrara in Italy found similar results.89They randomly assigned 104 postmenopausal women to receive either 60 g/d of anisolated soy protein or placebo for 12 weeks, after which time the women in thesoy group had a 45-percent reduction in hot flashes compared to a 30-percentreduction in the placebo group. An unpublished study of a soy germ ingredient(as Acatris' SoyLife, containing 10-percent soy isoflavones and .6-percenttocopherols) indicated that of 80 women, those who received soy showed a greaterreduction in hot flashes compared to those taking the casein placebo.
The research surrounding natural remedies for women's health isseemingly as plentiful as the conditions that affect women today. Femaleconsumers are used to dealing with the monthly irritations of menstruation, aswell as the constant threat of heart disease, breast cancer or osteoporosis.While women continue to turn to traditional medicine, they are also frequentingthe aisles of health food stores for adjuvant natural remedies. Regardless ofthe negative media hype that is ubiquitous in this industry, statistics haveshown that a large number of women remain faithful to the natural productsindustry. For this reason, it is important to keep the research coming and tocontinue supplying well-studied, safe ingredients for the supplements that lineretailers' shelves.
Nutrition in Pregnancy
During pregnancy, the mother's body donates many of its own nutrients to the developing fetus, which is why the National Academy of Sciences recommends higher doses of many nutrients during pregnancy. Conditions such as preeclampsia and anemia also can be alleviated with nutritional support.
A recent study published in the Journal of Nutrition reviewed nutritional interventions during pregnancy.98 The researchers, operating under the auspices of the World Health Organization (WHO), reviewed randomized controlled trials. They noted iron and folate supplements reduced anemia; calcium supplementation reduced the risk of preeclampsia and hypertension; and fish oil, vitamin E and vitamin C were "promising" for preventing preeclampsia and preterm delivery. Specifics on some of these nutrients include:
Calcium: During pregnancy, calcium needs almost double, as hormonal fluctuations change calcium metabolism while the fetus draws increasing amounts from the mother. A 2002 research review from Albion Advanced Nutrition in Clearfield, Utah, found that total circulating calcium in pregnant women was 5-percent less than that in non-pregnant women. Studies have indicated that calcium supplementation may also reduce the risk of preeclampsia and preterm birth99 and the risk of developing pregnancy-related hypertension.100
Iron: Iron-deficiency anemia is a common risk during pregnancy. Iron deficiency is also common after birth, according to researchers at the University of North Carolina, Chapel Hill. They determined through a retrospective cohort analysis of 59,428 participants that the prevalence of postpartum anemia was 27 percent. These rates were higher among minority women, reaching 48 percent among non-Hispanic black women.101
Bioavailability of iron is influenced by its form. A study comparing iron bis-glycinate chelate (as Albion's Ferrochel) to ferrous sulfate found that iron depletion existed in 30 percent of women on Ferrochel versus 55 percent of women on ferrous sulfate. The study also indicated women on Ferrochel had fewer adverse reactions, such as gastric disturbances.102
Magnesium: Magnesium works in concert with calcium to protect bone density levels. It also plays a role in regulating blood pressure, and may reduce the risk of preeclampsia.103
Vitamin C: Antioxidants such as vitamin C are required during pregnancy to protect the mother during this time of high physical stress, which can increase the incidence of oxidative damage. According to researchers at the University of Washington in Seattle, oxidative stress plays an important role in the development of preeclampsia.104 According to their case-control study of 109 women with preeclampsia and 259 controls, low levels of vitamin C led to a nearly four-fold increase in the risk of preeclampsia.
Omega-3s: Essential fatty acids (EFAs) benefit the body in a number of ways. A study at the Swedish Medical Center in Seattle found that long-chain omega-3 fatty acids (LC-PUFAs) reduced the risk of preeclampsia.105
Cranberries and cranberry juice continue to show benefits in women's health. For one reason, cranberries have several antioxidant constituents that lend them to various health applications. Investigators at the Fruit Laboratory of the U.S. Department of Agriculture's (USDA) Agricultural Research Service (ARS) studied the antioxidant capacity of several berries, including cranberries, and found the main component in cranberries is their anthocyanins, although they also contain free radical fighting quercetin glycosides and cyanidin 3-galactoside.90
Cranberry is probably most well-known for its role in protecting against urinary tract infections (UTIs) and bladder infections, and several studies have been published recently supporting this role. Cranberry juice is known to inhibit strains of E. coli and prevent bacterial adherence in humans,91 and there is scientific evidence supporting the use of cranberries in reducing the risk of E. coli adhesion to bladder cells and the onset of UTI.92 Company-sponsored in vitro research on a cranberry extract (as Cranbumycin, available from Wayne, N.J.-based Triarco Industries) indicated the antimicrobial effects of cranberry are effective against S. aureus, K. pneumoniae and E. coli. The anti-adhesion properties of cranberry juice, and its high-molecular weight nondialysable material (NDM), have also shown potential against S. mutans in saliva, thereby improving oral hygiene.
A research review of recurrent UTIs in women indicated cranberry juice has been found to be effective for prevention.93 A clinical trial comparing three regimens (placebo juice plus placebo tablets, placebo juice plus cranberry tablets, or cranberry juice plus placebo tablets) demonstrated that both cranberry juice and cranberry supplements were more effective than placebo at reducing the number of symptomatic UTIs experienced by 150 sexually active women over a year-long period.94
Aside from urinary tract infections, cranberry may have application in rheumatoid arthritis and heart health, two major concerns for women. Researchers at King's College London stated the protective effect of cranberry juice might be a useful approach in reducing the repeated episodes of Proteus upper UTIs that occur commonly in rheumatoid arthritis patients.95
As for heart health, cranberry juice was shown in a small study out of the University of Scranton, Pa., to lower heart disease risk by 40 percent.96 Volunteers drank one 8-oz. glass of cranberry juice per day for one month, two glasses per day for another month, and three glasses per day for the third month of the study. After three months, researchers noted a 10-percent increase in HDL levels, indicating a cardio-protective effect. Another heart health study conducted at the University of Wisconsin, Madison, indicated cranberry flavonoids protected against atherosclerosis, as well.97
For a full list of references to this story,click here.
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