Providing Holistic Health to Women
Women's Health
As women of all ages become increasingly conscious of their health, practitioners can help them take preventative measures by implementing healthy diets, lifestyle changes and natural products.
Now more than ever, women are taking a proactive approach when it comes to their health and wellness. Women are independent, savvy and conscious of their bodies’ needs, and they are not afraid to use products and professional assistance to meet them, whether they are physical or mental. Rather than waiting for problems to arise, many turn toward the natural products industry and naturopathic doctors to take preventative measures against various diseases and disorders.
Although women and men are susceptible to most of the same health issues, there are, of course, some that uniquely impact women. According to the U.S. Department of Health and Human Services Eunice Kennedy Shriver National Institute of Child Health and Human Development, some of these issues include gynecological health and disorders such as menstruation and menstrual irregularities; urinary tract health, including urinary incontinence and pelvic floor disorders; and disorders such as bacterial vaginosis, vaginitis, uterine fibroids and vulvodynia.
Furthermore, many women face pregnancy issues, which include “pre-pregnancy care and prenatal care, pregnancy loss (miscarriage and stillbirth), preterm labor and premature birth, sudden infant death syndrome (SIDS), breastfeeding and birth defects.” In addition, disorders related to fertility include “uterine fibroids, polycystic ovary syndrome, endometriosis and primary ovarian insufficiency.” Others include Turner syndrome, Rett syndrome, as well as ovarian and cervical cancers. Lastly, common issues related to “women’s overall health and wellness include violence against women, women with disabilities and their unique challenges, osteoporosis and bone health, and menopause.”
A study published on the Centers for Disease Control and Prevention’s (CDC) website, titled “Leading Causes of Death – Females – All races and origins – United States, 2017,” lists the top ten leading causes of death for women as heart disease (21.8 percent); cancer (20.7 percent); chronic lower respiratory diseases (6.2 percent); stroke (6.2 percent); Alzheimer’s disease (6.1 percent); unintentional injuries (4.4 percent); diabetes (2.7 percent); influenza and pneumonia (2.1 percent); kidney disease (1.8 percent); and septicemia (1.6 percent).
Given all of the health issues that can lead to severe complications or death, the market for women’s health supplements is strong and growing.
State of the Market
According to Grand View Research, “The global women’s health and beauty supplements market size was valued at $55.4 billion (U.S.) in 2021 and is expected to grow at a compound annual growth rate (CAGR) of 4.8 [percent] from 2022 to 2030. Various factors, such as the growing middle-class population, rising prevalence of various nutrition deficiencies among women, increasing access to supplements, availability of multiple products, and rising number of distribution channels and advertising strategies being adopted by major brands are driving the market.”
Another driving force for the market has been the COVID-19 pandemic, according to Dr. Stacey Smith, marketing and communications NORAM, Gnosis by Lesaffre (Lille, France with U.S. offices in East Brunswick, NJ). “COVID-19 has made consumers, in general, more aware of the importance of proactively supporting their health, but even more so for women, who are traditionally shopping for themselves and their families,” she noted. “COVID brought to light the importance of boosting our immune systems, as well as seeking out cardiovascular support. The former was evident with the increase in vitamin D3 sales; but research has also shown that K2 is an important nutrient for supporting our cardiovascular health in the wake of COVID.”
Dr. Smith continued, “In 2020, Preprints.org published a paper examining the link between outcomes in patients with COVID-19 and low vitamin K status compared to patients with better vitamin K status and healthy controls. The study also demonstrates a link to COVID-19 patients that had other health conditions such as cardiovascular diseases, which are linked to low vitamin K status, including a breakdown of tissue fibers as measured by elastin, which is involved with pulmonary disease.”1
Concerns for Women Patients
Tori Hudson, ND, co-owner of Vitanica (Oregon), a company specializing in supplements specifically for women, noted that “COVID has had an unfortunate big impact on anxiety and depression in women.” Indeed, according to an article on frontiersin.org titled “Women’s Mental Health in the Time of COVID-19 Pandemic,” “Even if the fatality rate has been twice higher for men than for women, the [COVID-19] pandemic has affected women more than men, both as frontline workers and at home.” The article notes that the pandemic can be particularly distressing during pregnancy. “In a Canadian study, two cohorts of pregnant volunteer women were compared. The first one was recruited before the COVID-19 pandemic; the second one online during the pandemic in April 2020. This study was only focused on distress and psychiatric symptoms. Women from the COVID-19 cohort as compared with pre-COVID-19 women showed higher levels of depressive and anxiety symptoms … Moreover, in the COVID-19 cohort, women with previous psychiatric diagnosis or low income were at higher risk to report elevated distress and psychiatric symptoms.”
Dr. Smith stated that “Women in their 20s and 30s are typically thinking about starting their families, so they want to ensure proper health and nutrition as they seek to conceive (i.e., fertility), and then to nurture their child, not only during pregnancy, but ensuring that their child maintains healthy nutrient levels through diet or supplementation.”
Furthermore, according to Dr. Smith, “Whether women recognize it, cardiovascular health is a serious issue for women of all ages. What was once thought of as a ‘man’s disease,’ cardiovascular disease develops seven to 10 years later in women than in men, yet it is still the major cause of death in women over the age of 65 years. The risk of heart disease in women is often underestimated due to the misperception that females are ‘protected’ against the cardiovascular disease.”2 She also noted that although cardiovascular issues typically develop later in life, it is still important for women to adopt healthy habits early to ensure their heart health will carry them into their senior years.
Dr. Smith continued, “The same can be said for bone health. We reach our peak bone mass in our 20s-30s. Once that peak is reached, that is all we will ever have. From there it is about staving off a steady decline of our bone mass, and women’s bone mass takes a sharper decline once they reach their menopausal years due to hormone changes. One in two women is expected to incur future bone fractures due to poor bone metabolism, whereas the risk to men is one in three.”
Another hurdle for women, Dr. Smith noted, is menopause, which “carries disruptive and uncomfortable symptoms, such as hot flashes, which can trigger further problems, such as insomnia, anxiety and depression, memory and concentration issues, and lower libido.” Many women also struggle with infertility, said Dr. Smith, and struggle to conceive. Although many of these issues are related to hormonal changes, she stated that many of them can be attributed to nutrient deficiencies. “In particular, a lack of vitamin K2 … for supporting bone and cardiovascular health, and folate for supporting fertility, cardiovascular health, menopausal symptoms and more,” can lead to many of the issues discussed.
Approaches/Products for Women’s Health
“I use a holistic approach with patients based on their current lifestyles,” said Dr. Smith. “Understanding their willingness to add certain stress management and supplementation to their daily routine is beneficial when taking into consideration their diet, physical activity and sleep hygiene. By asking open-ended questions about these lifestyle aspects, as a practitioner I can give even the simplest recommendations such as putting their fork down in between each bite of food, supplementing certain vitamins due to signs or symptoms of deficiency, and of course, utilizing some common lab testing to identify improvements in their blood work.”
As far as what Gnosis by Lesaffre offers, Smith shared that “Many practitioner-specific products feature our high-quality ingredients, including MenaQ7 Vitamin K2 as MK-7, and our Quatrefolic active folate.” Vitamin K2 as MK-7 supports bone and heart health, while folate supports fertility and conception, cardiovascular health, menopausal support and more.
“By activating K-dependent proteins already in the body, K2 simultaneously supports bone and cardiovascular health by helping the body properly utilize calcium. Osteocalcin binds calcium to the bone mineral matrix, while Matrix Gla Protein (MGP) inhibits calcium from depositing in arteries and soft tissues where it can cause them to stiffen, decreasing free blood flow.” She noted that MenaQ7 as MK-7 has been the source material for more than 22 human clinical trials confirming both bone and cardiovascular benefits, and more are currently underway.
Dr. Smith detailed two groundbreaking studies for MenaQ7 Vitamin K2 as MK-7. “A three-year study of 244 healthy post-menopausal women taking 180 mcg dose of MenaQ7 Vitamin K2 as MK-7 daily yielded unprecedented results: Clinically statistically significant protection of the vertebrae and the hip (femoral neck) against bone loss was the result of a daily nutritional dose of MenaQ7. After three years of supplementation, maintenance in both bone mineral content and bone mineral density were statistically significant in the MenaQ7 group, as well as statistically improved bone strength.”3 As far as cardio-protective evidence, Dr. Smith explained, “Using pulse wave velocity and ultrasound techniques, researchers observed the Stiffness Index ß in MenaQ7 group with initial high arterial stiffness had decreased significantly compared to the slight increase in the placebo group after three years of supplementation at a nutritional daily dose. Results confirmed that MenaQ7 not only inhibited age-related stiffening of the artery walls, but also made a statistically significant improvement in vascular elasticity.”4
Dr. Smith continued, “The three-year cardiovascular study results were confirmed in a one-year follow-up clinical study—this time in a population of 243 healthy men and women—which showed improved vascular health after daily supplementation with 180 mcg MenaQ7.”5
Quatrefolic active folate, Dr. Smith discussed, is for women seeking support for conception or fertility and folic acid is considered the standard of treatment. “However, considerable confusion exists about folic acid and the benefits available to a wider range of the population if folate supplementation is used in its place.” She elaborated, “‘Folate’ is the generic term given to vitamin B9, recognized as one of the mandatory vitamin supplements during pregnancy, and essential for a range of other conditions, like cardiovascular health, fertility, mood and cognition. Folate includes a group of structurally related compounds like: natural folates occurring in foods, which also exist in many chemical forms, predominantly in the polyglutamate form; folic acid, the man-made synthesized form added in dietary supplements and fortified foods; and the biologically active form 5-methyltetrahydrofolate (methylfolate), available also in small amount in foods and as food ingredient.” She noted that the terms “folate” and “folic acid” are often mistaken and used interchangeably, both by practitioners and consumers, often causing confusion.
Dr. Smith explained that the company’s Quatrefolic ingredient is “designed to act as a nutrient in all areas where folic acid supplementation has been recommended and allowed. Folic acid is the oxidized monoglutamate precursor form of folate. It was synthesized for the first time in the 40s, in pure crystalline form. It does not occur in nature and has no biological functions. To be utilized by the human body it must be metabolized and reduced to the enzyme methylenetetrahydrofolate (5-MTHF) by a multi-step enzymatic conversion. For some people, metabolization of folic acid might not be totally effective, due to unique genetic patterns of the enzyme methylenetetrahydrofolate reductase (MTHFR). Individuals expressing this polymorphism may have a variation in their ability to reduce folic acid. The incidence of people presenting a form of polymorphism MTHFR is about 40 percent worldwide.”
Lastly, Dr. Smith shared research performed on Gnosis by Lesaffre’s Quatrefolic acid ingredient. “Where fertility is concerned, International Journal of Environmental Research and Public Health has published a retrospective study investigating the role of supplementation with vitamin B complex (5-methyltetrahydrofolate as Quatrefolic from Gnosis by Lesaffre plus vitamins B12 and B6) versus folic acid (FA) on pregnancy outcomes (clinical pregnancy, pregnancy loss and live birth) in infertile women undergoing Assisted Reproductive Technologies (ART). Results showed that the Quatrefolic group had a higher chance of clinical pregnancy and live birth than those supplementing with FA alone.”
She continued, “The researchers recruited 269 infertile women: 111 were supplemented daily with Quatrefolic associated with other vitamin B and 158 with only FA. The results showed a higher percentage of women in the vitamin B complex group had a clinical pregnancy and live birth in comparison to the FA group, leading the authors to conclude that “women undergoing homologous ART supplemented with 5-MTHF and vitamin B12, have a higher chance of clinical pregnancy and live birth in comparison to those supplemented with only folic acid.”
While the researchers note—and we agree—that further prospective studies and randomized clinical trials are needed to elucidate the effects of folate, vitamin B12, and homocysteine pathway in improving pregnancy outcomes in women after ART, they stated, ‘If our findings were confirmed, this relatively inexpensive supplementation with vitamin B complex might be considered in clinical practice, particularly in women undergoing ART.’”6
Dr. Hudson, who has co-owned Vitanica for the last 28 years, started in 1994 in order to “bring to the clinicians and their patients, high quality women specific, women’s health formulas … with a focus on those conditions unique to only women or more common in women or some unique clinical characteristics in women.” She provided a few examples: for PMS, Chaste Tree, St. John’s wort and vitamin B6 have meaningful research in support for reliving PMS symptoms; NAC, resveratrol, curcumin and melatonin have supportive research for endometriosis; and NAC, myo-inositol, chromium, cinnamon, spearmint, licorice root and more have been researched to relieve symptoms of polycystic ovarian syndrome (PCOS), along with a low-starchy, healthy diet and exercise.
Advice for Practitioners
“One recommendation for practitioners is to consider supplementation with MenaQ7 Vitamin K2 as MK-7 for patients taking a statin,” said Dr. Smith. “In the process of reducing LDL-C levels, studies have shown statins actually deplete CoQ10 levels and inhibit the ‘synthesis of vitamin K2, the cofactor for MGP activation, which in turn protects arteries from calcification.’ So, while this drug is prescribed for one aspect of cardiovascular health, a side effect is that it simultaneously impacts two important cardioprotective nutrients.”
She continued, “Statins’ impact on CoQ10 levels are so widely recognized that practitioners often recommend patients on statins offset the side effect by taking a CoQ10 supplement. Yet no such recommendation exists for vitamin K2, even though this body of evidence is growing. The first revelation was a 2015 paper published in Expert Review of Clinical Pharmacology,7 but more recently a cross-sectional clinical study published in Kaohsiung Journal of Medical Sciences8 adds to the evidence that statins may enhance calcium accumulation in the arterial wall by inhibiting vitamin K-dependent proteins involved in vascular protection.”
Another recommendation that Dr. Smith offered is to “look for naturally inspired solutions to support their patients—the people who trust them and seek their expertise. The ingredients they suggest should truly be natural, healthy solutions with strong clinical studies that have confirmed safe, efficacious benefits. This is universally important but especially true for patients seeking reproductive help, where safety for the woman and the newborn is the highest priority.”
Dr. Hudson advised practitioners to “be studious about safe/effective natural medicine treatments and the research that is being done. Also, [it is] important to appreciate when our patients need pharmaceuticals and/or surgeries for prevention, and/or treatment.”
References:
1 Dofferhoff, A.S.; Piscaer, I.; Schurgers, L.J.; Walk, J.; van den Ouweland, J.M.; Hackeng, T.M.; Lux, P.; Maassen, C.; Karssemeijer, E.G.; Wouters, E.F.; Janssen, R. Reduced Vitamin K Status as A Potentially Modifiable Prognostic Risk Factor in COVID-19. Preprints 2020, 2020040457 (doi: 10.20944/preprints202004.0457.v1).
2 Maas AHEM and Appelman YEA. Gender differences in coronary heart disease. Neth Heart J. 2010 Dec; 18(12): 598-602.
3 Knapen MHJ, Drummen NE, Smit E, Vermeer C. Theuwissen E. Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporosis International. Sept 2013, Vol 24, Issue 9, pp 2499-2507.
4 Knapen MHJ, Braam LAJLM, Drummen NE, Bekers O, Hoeks APG, Vermeer C. “Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women. A double-blind randomized clinical trial.” Thromb Haemost. 2015 May; 113(5):1135-44.
5 Vermeer C and Vik H. Effect of Menaquinone-7 (vitamin K2) on vascular elasticity in healthy subjects: results from a one-year study. 2020 Vascul Dis Ther, 5.
6 Cirillo, M.; Fucci, R.; Rubini, S.; Coccia, M.E.; Fatini, C.5-Methyltetrahydrofolate and Vitamin B12 Supplementation Is Associated with Clinical Pregnancy and Live Birth in Women Undergoing Assisted Reproductive Technology. Int. J. Environ. Res. Public Health 2021, 18, 12280. https://doi.org/10.3390/ijerph182312280.
7 Okuyama H, Langsjoen PH, Hamazaki T, Ogushi Y, Hama R, Kobayashi T, Uchino H. “Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms.”Expert Rev Clin Pharmacol. 2015 Mar;8(2):189-99.
8 Zhelyazkova-Savova MD, Yotov YT, Nikolova MN, Nazifova-Tasinova NF, Vankova DG, Atanasov AA, Galunska BT. “Statins, vascular calcification, and vitamin K-dependent proteins: Is there a relation?” Kaohsiung J Med Sci. 2021 Feb 26. Online ahead of print.
Healthy Take Aways
• According to Grand View Research, “The global women’s health and beauty supplements market size was valued at $55.4 billion (U.S.) in 2021 and is expected to grow at a compound annual growth rate (CAGR) of 4.8 [percent] from 2022 to 2030.
• According to the U.S. Department of Health and Human Services Eunice Kennedy Shriver National Institute of Child Health and Human Development, some of the most common health issues for women include gynecological health and disorders such as menstruation and menstrual irregularities; urinary tract health, including urinary incontinence and pelvic floor disorders; and disorders such as bacterial vaginosis, vaginitis, uterine fibroids and vulvodynia.
• Many women face pregnancy issues, which include “pre-pregnancy care and prenatal care, pregnancy loss (miscarriage and stillbirth), preterm labor and premature birth, sudden infant death syndrome (SIDS), breastfeeding and birth defects.”
• Common issues related to women’s overall health and wellness include violence against women, women with disabilities and their unique challenges, osteoporosis and bone health, and menopause.
For More Information:
Gnosis by Lesaffre, www.gnosisbylesaffre.com
Vitanica, www.vitanica.com
