Women are said to have 70–80% of the buying power in this country (1). What are you doing to make your store and its offerings appealing to them? Make sure your staff is up to date on women’s top health concerns and are prepared to help female shoppers make good choices.

Women and Cardiovascular Disease One in three U.S. women has cardiovascular disease and 6.6 million women are living with coronary heart disease (CHD). Sadly, 64% of women will die from CHD with no previous symptoms (2).

It’s hard to say why women may be more prone to heart issues than men, but one study suggests that women are less healthy than men in general, particularly those in the 18–55 years age group (3). For instance, women had more incidences of diabetes (40% versus 27%), obesity (55% versus 48%) and depression (49% versus 24%) than men in a group of nearly 3,000 co-ed individuals.

“It’s a serious health concern that goes overlooked until there is a problem—yet, it’s often a preventable and manageable condition. Women of all ages need to care for and protect their hearts against common risk factors,” says Carolina Burki-Sozzi, director of product development at Horphag Research (worldwide exclusive supplier of Pycnogenol), Hoboken, NJ.

How can retailers support women interested in heart health supplements? Well, for one, remind them of old standbys in the category (like omega-3s, which provide broad-spectrum heart health support), and try pointing them to some often overlooked nutrients identified by industry experts.

Burki-Sozzi believes this list should include French maritime pine bark extract. A branded form from her company (Pycnogenol) has an interesting property: it supports healthy circulation. “Along with healthy diet and exercise, daily supplementation of Pycnogenol can help to significantly reduce oxidative stress, enhance endothelial function for improved blood pressure, increase the relaxation of constricted blood vessels and even help to maintain healthy cholesterol,” according to Burki-Sozzi.

Several key studies highlight the benefits of Pycnogenol for heart health. In a 2015 study, daily supplementation with Pycnogenol improved endothelial function by 55% after eight weeks, and by 66% after 12 weeks. Study participants had borderline hyperglycemia, high cholesterol or high blood pressure (4).

In a 2012 crossover trial, the same herb was studied in 23 coronary artery disease patients. Participants took 200 mg/day of Pycnogenol for eight weeks and then a placebo after washout (or vice versa). Pycnogenol improved flow-mediated dilatation of the brachial artery, while no such benefit was found with the placebo (5).

Another heart-supporting herb to discuss with shoppers is hawthorn. According to Mary Bove, N.D., medical educator and advisory board member for Gaia Herbs, Brevard, NC, the herb “provides antioxidant support and promotes healthy circulation, particularly in the small coronary arteries that support the heart muscle. It supports the electrical system that regulates the heartbeat, too.”

Some of these benefits may be attributed to the herb’s rich source of oligomeric procyanadins (OPCs). David Winston, RH (AHG), founder and president of Herbalist & Alchemist, Washington, NJ, says OPCs help stabilize cardiovascular tissue and provide antioxidant, anti-inflammatory and mild vasodilator activity. He believes hawthorn is useful for supporting healthy, flexible arteries, healthy blood pressure and cardiac function.

Cheryl Myers, head of scientific affairs and education, EuroPharma, Inc., Green Bay, WI, is a firm believer in the ability of curcumin to support heart health, since chronic inflammation can lead to heart disease, especially in the lining of the blood vessels. “Inflammation in the cardiovascular system can lead to blockages and weakening of the vessels and curcumin has been proven to safely inhibit the inflammatory cascade,” she explains.

Myers says that curcumin inhibits tissue factor (which may contribute to thrombosis) and modulates nitric oxide (NO) production, “which is important for proper blood vessel function.”

Another antioxidant to keep in front of shoppers is coenzyme Q10 (CoQ10), which Marci Clow, M.S., RDN, at Rainbow Light, Santa Cruz, CA, says is critical for maintaining a healthy cardiovascular system. Not only does it help power the body at the cellular level, but it also offers antioxidant support throughout the body. CoQ10 levels tend to decrease with age and statins use.

One connection to the circulatory system, says Clow, is that if low-density lipoprotein (LDL) oxidizes, it may cause atherosclerosis and lead to heart attack, ischemic strokes and coronary heart disease. “Studies have suggested that the content of CoQ10 in human LDL lowers atherogenic rates,” she states.

Another part of the heart-health connection is that healthy CoQ10 levels are linked with small decreases in blood pressure in some studies. In fact, low blood levels of CoQ10 have been found in people with hypertension, says Clow, “although it is not clear if CoQ10 ‘deficiency’ is a cause of high blood pressure.” She says that CoQ10 may also be a predictor of mortality in chronic heart failure.

Women may also want to hear about fibrin. Maday Labrador, Ph.D., vice president of education at Enzymedica, Venice, FL, says this protein moves through the blood and sticks to the walls of blood vessels. Excess amounts have been linked to chronic inflammation and heart attack, so Labrador says, “maintaining healthy levels of fibrin promotes healthy blood coagulation for an optimally functioning cardiovascular system.”

She believes that nattokinase is beneficial for those worried about their fibrin levels, since it helps break down fibrin in the blood. She explains that her company offers a form of nattokinase with NSK-SD (Natto-K), which does not contain vitamin K2, but enhances plasmin production.

Meanwhile, other shoppers seek out vitamin K2 because it supports “the management of calcium in circulation,” according to Neil E. Levin, CCN, DANLA, senior education manager at NOW Foods, Bloomingdale, IL.

Vitamin K2 is vital for ensuring normal blood vessel elasticity. Michael Mooney, director of science and education at SuperNutrition, Oakland, CA, says that K2, especially the menaquinone-7 (MK-7) form, “‘powers’ osteocalcin (OC), which tells calcium to go into bones and teeth, and matrix Gla protein (MGP), which tells calcium to stay away from soft tissues such arteries, kidneys and ligaments.”

Eric Anderson, senior vice president of global sales and marketing, NattoPharma USA, Inc., Metuchen, NJ, believes that women should consider taking vitamin K2 as MK-7 as part of their regular nutritional regimen. “Daily consumption can keep cardiovascular arteries pliable, contributing to endothelial health,” he states.

Anderson adds that arterial calcification was once thought to be an inevitable part of the aging process. But he points to studies that suggest arterial calcification is an actively regulated process. He says, “In fact, unpublished research has shown that healthy arterial tissues have been observed to contain 100 times more vitamin K2 than calcified arteries—meaning that simply supplementing with vitamin K2 can actively protect the cardiovascular system.”

One three-year study published in 2015 involving 244 healthy post-menopausal women suggested that taking 180 mcg of MK-7 (as MenaQ7 from Nattopharma) actually decreased arterial stiffness and improved vascular elasticity, especially in women who had the most significant arterial stiffness of all (6). “In short, the results showed that arteries actually became more flexible over the three years,” says Anderson.

It’s especially important for people on certain medications to consider taking K2. “What many people—even physicians—don’t realize is that adequate vitamin K is needed for common blood thinning drugs (anticoagulants) to work properly because they alter the vitamin’s effect on clotting. People on these medications typically don’t need to avoid vitamin K—that could actually be counterproductive—instead they need to avoid wide swings in vitamin K intake from day to day,” Levin points out.

One last nutrient to put on women’s radars is magnesium, which Marita Schauch, BSc., ND, women’s health educator on behalf of Natural Factors, Monroe, WA, and naturopathic physician, calls “an often under-appreciated mineral that so many of us are deficient in.” Erin Stokes, N.D., medical director of MegaFood, Manchester, NH, agrees, adding that shoppers may know of magnesium for its support of muscle relaxation, but its connection to cardiovascular health is often overlooked.

Schauch explains that low magnesium levels may contribute to atherosclerosis and cardiovascular disease because the mineral offers many protective factors within the lining of the arteries.

“The level of magnesium in the blood also correlates with the ability of the heart muscle to manufacture enough energy to beat properly,” she states, noting that many types of cardiac arrhythmias are related to low levels of magnesium in the heart muscle.

Breast Health and Estrogen The triggers, pathways and predispositions that lead to breast cancer are not well understood, even though about 12% of U.S. women will develop invasive breast cancer at some point in their lives, and more than 40,000 women are predicted to die from the disease annually (7).

While it won’t cure, treat or prevent disease, good nutrition is a factor in maintaining healthy breasts throughout life. This includes eating plenty of phytonutrient-rich fruits, vegetables and whole grains. But, one topic women may be unclear about is whether soy falls in the good or bad category because it contains isoflavones that may mimic estrogen in the body.

Myers states, “The dark side of estrogen’s activity is overstimulation of breast cell replication and even weight gain.”

But, Clow explains that phytoestrogens (like that found in soy and some other plants like beans, lentils and peanuts) may mimic estrogen in the body, but they are not nearly as strong as the body’s natural estrogens. In fact, they may also have protective properties for the breasts. Says Clow, “When there is an estrogen deficiency, phytoestrogens such as isoflavones will exhibit weak estrogenic behavior and bind to the estrogen receptor sites. If there is an excess of estrogen, the isoflavones may exhibit anti-estrogenic activity.” Moreover, when large amounts of estrogen are present in the body, she believes isoflavones may play a role in helping the body excrete it and achieve a healthy hormonal balance.

This is important, as Claire Barnes, technical advisor at Protexin/Bio-Kult, Somerset, UK, says that high levels of estrogen over the long term are a risk factor for breast cancer (8). “If estrogen levels are particularly high, and removal of excess estrogen in the body is reduced, estrogen may build up where there are estrogen receptors, such as in breast tissue,” Barnes explains.
“Nutrients and dietary factors certainly can impact a woman’s well-being during the premenopausal years.” —Marci Clow, Rainbow Light
Therefore, Tori Hudson, N.D., director of research and education of Vitanica and medical director of A Woman’s Time, Portland, OR, believes women shouldn’t shy away from soy consumption. “In fact, soy foods/supplements can reduce breast density (a risk factor for breast cancer) and bind to estrogen receptor beta (again, protective aspect regarding breast cancer),” she states.

In fact, Winston says some studies have looked at the Japanese population, which tends to consume a large amount of fermented soy. He says Japan has much lower rates of breast cancer than many western countries.

Hudson adds that three very large published studies show “breast cancer survivors who consume more rather than less soy (one serving a day is recommended) actually have better outcomes from their breast cancer.”

Levin points out that the American Cancer Society says eating soy is likely safe for most women. The group states, “studies in humans have not shown harm from eating soy foods. Moderate consumption of soy foods appears safe for both breast cancer survivors and the general population, and may even lower breast cancer risk” (9).

Myers believes, however, that individuals should stay away from eating soy foods at every meal: “If one eats soy cereal with soy milk for breakfast, a soy protein shake for lunch and a soy burger with soy chips for dinner, that may be problematic, for anyone, not just women with breast health concerns.”

What else can help maintain healthy breasts? According to Barnes, having a healthy bowel flora can support the removal of excess estrogen through the intestines and limit its reabsorption through the intestines so it does not re-enter the bloodstream (10). “Consuming probiotics and adequate fiber may help with the excretion of excess estrogen,” Barnes states.

Schauch says taking certain supplements (omega 3s, vitamin D, DIM, I3C, sulforaphane) can maintain breast health while others suggest maitake, glutathione and other powerful antioxidants.

Myers says her firm recently launched a breast health supplement (CuraMed Breast) that includes a high-absorption curcumin, low-molecular weight OPCs from French grape seed, pomegranate and vitamin D. “The focus of each ingredient is to provide powerful support for breast health for years to come,” she states.

Cooling Off Menopause Menopause may be an inevitable part of a woman’s lifecycle, but does that mean hot flashes and other perimenopause system are unavoidable?

Says Clow, “Unfortunately, menopause and the symptoms that come with it are indeed inevitable, as women head into the menopausal years have declining hormone levels that contribute to many common symptoms such as hot flashes, lowered sex drive, reduced vaginal lubrication, depression, fatigue and concerns about increased risk of reproductive cancers.”

Herbal support. Experts say some herbs can help keep women healthy and comfortable during perimenopause, but there’s a lot of misinformation circulating about the category. For one, Hudson says, “Not all women will have hot flashes with perimenopause/menopause, but it is the most common menopause symptom, and on average can last 7.5 years.”

Another misconception, Winston says, is that “black cohosh is the menopause herb” for all women. “The majority of women taking this herb will be underwhelmed by its very modest ability to reduce hot flashes or night sweats,” he states.

The reason why is that he believes no single herb can support all facets of complex issues like menopause. Plus, herbs often function most effectively when they are used in combination. “This means that herbs, when skillfully combined, create a greater level of activity and efficacy. So, instead of 1 + 1 = 2, it equals 3 or 4.”

An example he provides for benefiting perimenopausal women is that a combination of chaste tree (Vitex agnes-castus), black cohosh, blue vervain, dang gui and night blooming cereus is “vastly more effective for relieving hot flashes, night sweats, formication (skin crawling) and menopausal depression or anxiety than any one of these herbs by itself.”

Nonetheless, some experts believe that black cohosh has sufficient research support to help women in its own right. Myers notes that it is not a phytoestrogen. Rather, it is thought to be a selective estrogen receptor modifier, “meaning it flips on some of the estrogen switches in the brain and vaginal lining (and potentially bone), but does not flip switches in the uterus and breast. This makes it much safer than hormonal products for alleviating menopause and perimenopausal symptoms.”

Mooney cites one placebo-controlled study of 149 perimenopausal and postmenopausal women in which black cohosh offered benefits at doses as low as 40 mg of extract per day in 70% of participants (11). A separate review found that black cohosh “helped to reduce hot flashes in as many as 80% of users within one month” (12).

In the end, the choice of black cohosh raw material may be one of the most important factors to consider. Myers, for instance, feels this herb is most effective when the correct species and standardization are used.

Joe Veilleux, general manager of Euromed USA, Presto, PA, says cases of liver toxicity have been linked with species from China, but not U.S. black cohosh roots. The U.S.-grown form is all wild crafted and in limited supply. “This makes the root material of sufficient high cost that it attracts unscrupulous players who use adulterated materials, and dubious inexpensive species, to try and gain an economic advantage,” says Veilleux.

Ensuring quality, says Veilleux, means manufacturers need to use suppliers that are serious about product testing. He says his firm uses 20 different lab tests in its manufacturing of black cohosh, and all its extracts. “The process starts with the training of wild crafters to identify and harvest only the correct black cohosh species. Then, species testing of the harvested black cohosh root material is done by sophisticated chemical techniques. Additional testing is done throughout the extraction process,” Veilleux explains.

Moving away from black cohosh, Hudson also speaks of some plant-based supplements that have “compelling research for hot flashes,” like gelatinized maca and Siberian rhubarb. In one study of 20 early-postmenopausal women, researchers assessed the effects of taking 2 g of gelatinized maca root powder daily. They found that the maca acted like a “toner of hormonal processes” in that follicle-stimulating hormone decreased while luteinizing hormone increased. They stated, “Changes in hormone levels were accompanied by substantially reduced feeling of discomfort associated with menopause, although, there was a distinctive, positive placebo effect” (13).

Bove also believes, “Adaptogens like maca can be nutritionally supportive for the endocrine pathway and help support during this transition.” The reason why, she says, is backed up by the aforementioned study: that they support hormonal balance during menopause—exactly what women need during that time.

Regarding Siberian rhubarb, one study gave the herb or a placebo to 112 perimenopausal women with menopausal symptoms. By 12 weeks, women’s scores on the Menopause Rating Scale were significantly reduced (from 27.0 ± 4.7 points to 12.4 ± 5.3 points). Meanwhile, placebo caused a much smaller reduction (27.0 ± 5.3 points to 24.0 ± 6.2 points) (14).

Select Women’s Health Offerings

Enzymedica: Enzyme Nutrition Women’s, Enzyme Nutrition Women’s 50+, Digest Women’s 50+.

Euromed USA: Standardized Botanical Extracts.

EuroPharma, Inc. (maker of the Terry Naturally): Tri-Iodine, CuraMed Breast, Menopause Relief, BoneSil, PMS Relief, Hair Renew Formula and Omega 7.

Fruit d’Or Nutraceuticals/RS Specialty Ingredients: Organic Cranberry Cran Naturelle (raw material) as formulated in supplements such as UP 4 by UAS Life Sciences.

Gaia Herbs: Adrenal Health Jump Start, Adrenal Health Nightly Restore, Black Cohosh, Caste Tree Berry (organic), Daily WellBeing for Women, Dong Quai Root, Motherwort Tops (organic).

Genesis Today: Pycnogenol, Probiotic, Cranberry U.T. Complete.

Helios Corp.: EstroG-100, CranC-Plus.

Herbalist & Alchemist: David Winston’s Uterine Tonic, David Winston’s Women’s Calmpound, David Winston’s Women’s Formula, David Winston’s Full Moon Women’s Anti-Spasmodic, David Winston’s Reckless Blood Tonic, David Winston’s Replenish Compound, David Winston’s Women’s Transition Compound.

Horphag Research: Worldwide exclusive supplier of Pycnogenol.

Maxim Hygiene Products: Feminine hygiene products.

MegaFood: Multi for Women, Multi for Women 40+, Multi for Women 55+, Women’s One Daily, Baby & Me 2, Baby & Me, MegaFlora for Women, MegaFlora for Baby & Me and Daily Maca Plus Women Over 40.

Nattopharma USA: Global supplier of MenaQ7 Vitamin K2 as MK-7.

Natracare: Organic feminine hygiene products.

Natural Factors: WomenSense EstroSense, WomenSense AdrenaSense, WomenSense MenoSense, WomenSense ThyroSense, WomenSense RxOmega-3 Women’s Blend and WomenSense MagSense.

NOW Foods: EVE Women’s Multivitamin, Prenatal Gels + DHA, NOW Menopause Support, Herbal Pause and Natural Progesterone Liposomal Skin Cream (unscented or Lavender).

Premama: Premama Fertility Reproductive Support Supplement, Premama Essentials and Essentials Plus Prenatal Vitamin Drink Mix, Premama Digestive Aid Prenatal Fiber and Probiotic Chew and Premama Lactation Support Drink Mix.

Proprietary Nutritionals Inc.: Cran-Max, L. fermentum LF10 (DSM 19187) and Lactobacillus acidophilus LA02 (DSM 21717).

Protexin: Bio-Kult Probiotic multi-strain formula for healthy digestive and immune systems, Bio-Kult Candéa Advanced probiotic multi-strain formula, Bio-Kult Pro-Cyan Advanced triple action formula.

Rainbow Light: PMS Relief, Black Cohosh Meno-Relief, Complete Menopause Multivitamin, Embrace Prenatal 35+, Prenatal One, Complete Prenatal System, Prenatal Petite Multivitamin, Prenatal DHA Smart Essentials, Certified Prenatal Multivitamin.

SuperNutrition: SimplyOne Women, Women’s Blend and Menopause Multiple. Various prenatal vitamins.

Vitanica: Menopause Support, Menstrual Cycle Support, Pregnancy Support, Vaginal Suppositories and more.
Switching gears, Labrador says that enzymes can also support women going through menopause since they often go through changes in their digestion around age 50. “Occasional appetite, gas, bloating indigestion and bowel deviations may occur more frequently,” she states, noting that digestive enzymes may help.

Next, French maritime pine bark may support women experiencing menopause and perimenopause symptoms by reducing their frequency and severity. In one study of 170 perimenopausal women, those taking Pycnogenol had improvements in many symptoms, with an overall 56% reduction in symptom severity. Vasomotor- and sleep-related symptoms were the most improved (15). In a separate study involving 38 women, Pycnogenol was responsible for a reduction in numerous menopause symptoms (16). Says Burki-Sozzi, “Participants reported a decrease in severity of hot flashes, as well as a decrease in bloating and an improvement of digestive problems. Pycnogenol was also shown to improve symptoms that caused general discomfort and pain in participants.” Clow believes that though fewer clinical trials have been done on dong quai, “it is still worth recommending for easing symptoms associated with the woman’s reproductive cycle such as fatigue, dryness and perhaps hot flashes.” One study even found some benefits for those experiencing anxiety (17).

Many women want to avoid soy-based ingredients and anything that may have estrogenic properties. For these women, Levin likes a branded ingredient (EstroG-100 from Helios Corp.) that combines three botanical extracts: Phlomis umbrosa, Cynanchum wilfordii and Angelica gigas Nakai. “There are compelling studies on this soy-free herbal blend that demonstrate that it can help with most of the common menopause symptoms without having a direct effect on estrogen receptors,” he states.

Levin says studies suggest EstroG-100 “represents a clinically validated, innovative and natural alternative to traditional menopause symptom supplements based on improvements shown by the Kupperman Menopause Index in areas such as hot flashes, night sweats, nervousness, occasional sleeplessness and mood.”

In one 12-week study, EstroG-100 or a placebo was given to 64 women with pre-, peri- or postmenopausal symptoms. The supplement helped relieve symptoms of vasomotor, the feeling of pins and needles, insomnia, nervousness, melancholy mood, vertigo, fatigue and rheumatic pain, while the placebo did not. Also vaginal dryness was significantly improved (18).

Other botanicals to consider include herbs that are sources of phytoestrogens, such as red clover, alfalfa, Avena sativa, sage, motherwort and damiana, according to Mooney. Hudson says there have been other positive results for the use of fish oil, grape seed extract, St. John’s wort, hops, kudzu and more in women experiencing uncomfortable menopause symptoms.

The case for adrenal support. Adrenal support is also key for women during menopause. Schauch states, “Many women don’t realize that there are plenty of things they can do to prepare for menopause,” and she feels that securing adrenal health tops the list. “The adrenal glands assume the role of hormonal output when the ovaries shut down during menopause,” she explains. “The most valuable nutrients and herbs for menopause are: black cohosh, vitamin B6, bioflavonoids (hesperidin, quercetin), EPO and dong quai.”

Barnes agrees that some menopause issues are not only indicative of imbalanced hormones, but also adrenal burnout caused by high levels of continuous stress. She believes that probiotics may help. “Probiotics have also shown benefit in clinical studies improving stress, balancing hormones and improving mood,” she states (19).

For instance, researchers have studied the effect of probiotics on perimenopause-related vaginal dryness, a condition that Barnes says is related to estrogen loss. In one study, researchers found an inverse relationship between the presence of Lactobacillus in the vaginal flora and dryness. Those with more bacterial diversity were more likely to experience moderate to severe vaginal dryness (20). “Their study supported the view that Lactobacillus in the vaginal flora is reduced in menopause,” says Barnes.

Nutritional Support for Fertility Did you know that nearly 12% of women have trouble getting pregnant or sustaining a pregnancy, and nearly half of these women sought out help (21)?

While supplements retailers can’t provide treatments, they can offer nutritional support. But the issue is complicated, Hudson says. Some nutrients have research backing for a specific component of fertility, but shoppers (and their physicians) may not have pinpointed the cause for the fertility issue. For instance, she believes that chaste tree and/or rhodiola and/or maca support a healthy anovulatory cycle and hormonal balance; vitamin C benefits egg quality; arginine supports proper sperm formation; and zinc benefits sperm motility and formation.

Again, make it clear to shoppers that these options are by no means a magic bullet to conception. “Fertility issues can be devastating (and crazy expensive), and to give someone false hope that by taking a supplement that perhaps their chances will improve, is just plain not okay,” Clow states.

Retailers may want to focus instead on some more general ways to support preconception nutrition and normal fertility. “Even with the healthiest diet, nutrient deficiencies are clearly prevalent. Focusing on filling these gaps in the diet before conception helps to ensure a healthy start to pregnancy,” Stokes adds.

For this reason, many experts recommend taking a prenatal supplement several months before trying to conceive. Bove states, “Research is finding now that there’s a period of time, about six months before conception, which sets the genetic material that will actually contribute to what the fetus’ health picture will look like.”

She says if a woman has nutritional gaps during this time, her baby may be at a disadvantage such as being more likely to develop metabolic syndrome years down the road.

Tell women trying to conceive that another reason to take a prenatal is for the folic acid. Clow says it’s critical to have good stores of this nutrient in the body because a fetus relies on it for proper neural tube development—often before a woman even knows she is pregnant. “Studies show that 70% of neural tube defects could be prevented with folic acid supplementation!” she says.

Megan Bell, marketing and sales manager at Premama, Providence, RI, agrees that it’s important to have a “balanced prenatal foundation” before preconception. Her company has a prenatal drink mix (Premama Fertility Reproductive Support Supplement) intended for this purpose, which she says includes ingredients “clinically proven to increase egg quality and increase ovulation.” Myo-inositol is one ingredient said “to help improve ovulatory function and egg quality.”

Shoppers have tons of choices for their prenatal, so Levin suggests comparing formulas very closely. “They will vary in how much of the essential nutrients are in it, especially the macrominerals calcium and magnesium,” he states. Both are important for the baby’s and mother’s health.

Levin adds that women should also make sure to get enough DHA, since it’s not often found in prenatal supplements. “If not fish oil, then an algae source is recommended to enhance development of the child’s brain and nerves,” he explains.

Myers makes the point that women may be concerned about purity and heavy metals, however. She says that a salmon product (Vectomega) from her company is unique because it has “higher absorption, less can be used and because it is not from the body fat of the fish, it is much lower in certain toxins like PCBs.”

Stokes says while retailers are comparing labels, pay attention to the form of iron (look for one that’s easy to digest) and choline. She states, “Choline is an essential nutrient required for many vital physiological processes in the body, and recent studies have identified that common diets may be deficient or low in choline. This nutrient is not commonly found in prenatal multivitamins, and I believe it’s an important addition.

Also, check the iodine content because it is required for proper brain development, supports immunity and detoxification. “All pregnant women should discuss iodine supplementation with their healthcare practitioners to see if it is right for them,” Myers says.

She brings up another good reason to talk to their doctors about iron. Poor thyroid function may stand in the way of conception for some women. “Women with slightly lower thyroid hormone production frequently have impaired ovulation, which is one common cause of difficulty in becoming pregnant,” she explains.

Meanwhile, Barnes believes both men and women looking to start a family could benefit from probiotics. She says a healthy vaginal flora supports normal fertilization and sperm motility (22). “In men, bacterial infections in the male genitourinary tract may induce male infertility (23),” Barnes states.

Stokes also believes that a probiotic is an important supplement for fertility support and for after conception “to support the immune health of the mother and developing baby.”

Stress can also play a role in a successful conception, since it can affect healthy, balanced hormone levels—key to conception. If stress is a factor in a fertility and conception, Bove feels that adaptogens like rhodiola, ashwagandha and holy basil are good choices to take for three months before trying to conceive, and then discontinuing the regimen when couples are attempting conception. “These three adaptogens, by helping support a healthy stress response, help support good tissue differentiation during the first trimester. This encourages and supports healthy fetal development,” she believes.

Healthy Microflora While most shoppers are comfortable with the idea of good and bad bacteria taking up residence in the digestive tract, the same may not be true of vaginal microflora. Says Mitch Skop, senior director product development, Pharmachem Laboratories Inc., Kearny, NJ, “Many women still need to learn the connection between probiotics and vaginal health and balance.”

Schauch explains that several species of Lactobacillus take up residence in the vagina such as L. acidophilus, L. crispatus, L. jensenii, L. fermentum and L. gasseri. She states, “Lactobacillus helps to contribute to the low vaginal pH that is so important in maintaining a healthy vaginal microflora. Lactobacilli have also been shown to prevent the adherence of bad disease-causing bacteria.” For this reasons, she believes oral supplementation with this genus of probiotic can support healthy vaginal microflora. B

arnes explains that having healthy levels of Lactobacilli in the vagina creates an acidic environment that protects women from infection. “Studies have shown that vaginal flora low in Lactobacilli may lead to conditions such as bacterial vaginosis, candida and UTIs,” she states.

Levin says part of the reason why is that these bacteria make bacteriocins, lactic acid and hydrogen peroxide to regulate their environment, which is beneficial to a women’s vaginal health, too.

Skop describes a study investigating the effects of a probiotic on vulvovaginal candidiasis (VVC), what he says is the second most common cause of vaginitis. “It is diagnosed in up to 40% of women with vaginal complaints in the primary care setting,” he states.

A group of 30 women with VVC were given probiotics (L. fermentum LF10 [DSM 19187] and L. acidophilus LA02 [DSM 21717]) via a slow-release effervescent vaginal tablet (ActiCand 30 product). Tablets were used daily for a week, then every three nights for three more weeks, and then weekly to maintain a long-term vaginal colonization. At the end of the study, researchers found these probiotics helped eliminate candida yeast symptoms after 28 days in 86.6% of the women (24). Skop explains that these benefits may be attributed to the tablet’s ability to form “an anaerobic environment due to the release of CO2 and the second guaranteed by the colonization and adhesion to the vaginal epithelium of the two probiotics L. fermentum LF10 and L. acidophilus LA02.”

But, women have a lot more to think about than just probiotics. Labrador makes the case that certain enzymes are helpful for supporting balanced yeast levels. A supplement from her company (Candidase) uses “two enzymes to support balanced yeast levels, cellulase and protease. Cellulase breaks down the yeast cell wall, while protease digests the interior proteins. This combination provides a gentle, cleansing effect without the harsh discomforts common to cleansing.”

Meanwhile, another supplement from her company (Candidase Extra Strength) adds essential oils with natural antioxidant and anti-fungal properties and one billion CFU of probiotics.

Another ingredient that supports women’s microflora is cranberry, which is well known to support a woman’s urinary health. Says Dean Mosca, president of Proprietary Nutritionals Inc., Kearny, NJ, “Women tend to experience painful, embarrassing and annoying urinary tract infections multiple times more than men do. And women by the droves are more skittish than ever about upsetting their flora imbalance through antibiotic courses, desiring effective alternatives.”

He says research suggests that his company’s cranberry ingredient (Cran-Max) prevents the adhesion of some bacteria (like E. coli) in the urinary tract, which is often responsible for UTIs. He notes that a study comparing this ingredient with the number-one prescribed antibiotic for UTIs found the supplement was about as effective as the drug in shortening UTIs without any side effects (25). Says Mosca, “Unlike antibiotics which kill bacteria, cranberry works by changing the bacterial structure and preventing adhesion to tissues so it works effectively for prevention without the risk of developing antibiotic resistance.”

There’s a lot to learn about the connection between cranberries and women’s health and even the gut health connection. Stephen Lukawski, director of sales and business development for Fruit d’Or Nutraceuticals, Villeroy, QC, Canada, and CEO of RS Specialty Ingredients, says, “The future of cranberry is all about gut health, which has shown to be a star ingredient as the best defense for optimum vaginal health—it’s anti-invasion versus anti-adhesion. It’s now about prevention versus treatment, and cranberry whole food powder should be taken every day by every woman for maximum health benefits.”

Information supplied by Genesis Today, Austin, TX, suggests that shoppers should be aware of the proanthocyanidin (PAC) content in the cranberries. The company states, “We chose to focus on delivering a leading PAC content as it is believed PACs provide inflammation support against UTIs.” The cranberry extract (Cran d’Or) in one of the company’s supplements (Cranberry U.T.) delivers 135 mg of PACs per serving, “providing consistent antioxidant support.”

Lukawski points out that there’s a big difference in quality among cranberry supplements and even cranberry juice. “Women should ‘Be Berry Aware’” about this issue, he states. “Cranberry juice powder is not the answer for vaginal health. Women need to focus on purchasing cranberry powders that contain the whole fruit and are standardized for efficacy and quality. Clean.”

And consider offering combination products. “In my opinion, the best-quality products for vaginal health are a combination of cranberry and probiotics,” says Lukawski. Meanwhile, Barnes adds that garlic’s anti-microbial properties may help those concerned about Candida albicans because it “inhibits its growth and transition into its invasive fungus form” (26).

She also believes that using grapefruit seed extract is helpful “as an anti-fungal inhibiting the growth of Candida albicans by disrupting the cell membrane and preventing attachment to the gut wall” (22).

One last important issue women need to think about is their feminine hygiene. Rebecca Alvandi, vice president of Maxim Hygiene Products, Mineola, NY, says anecdotal evidence from her company suggests that using organic and natural chlorine-free cotton menstrual care products makes for a more comfortable menstrual cycle. She states, “Women with the most sensitive skin tell us how they no longer get rashes with our products and others tell us about the more comfortable experience they have with our more breathable product.”

She adds that toxic shock syndrome (TSS) is still relevant today with some fairly high-profile recent cases, including former model Lauren Wasser, who lost her legs to the illness. Some believe that using tampons made with organic cotton lowers the risk of developing TSS because synthetic tampon ingredients and their higher absorbency may create an environment favorable to the bacteria that cause TSS (27). WF

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Published in WholeFoods Magazine September 2016