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Women's Health


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Women's Health Information:

Osteoporosis. Iron deficiency. Weight reduction.  PMS. Incontinence. Menopause. Skin care. What do these things have in common? They are either unique to women, or are more of a concern to women. They affect current recommendations on what women should eat for optimum health.

While new information on what's good and what's bad seems to surface almost daily, some basic guidelines have taken root over the past several years.

The bottom line (also known as the Dietary Guidelines for Americans, from the Departments of Health and Human Services and Agriculture) is:

  • Eat a variety of foods
  • Maintain healthy weight
  • Choose a diet low in fat, saturated fat, and cholesterol
  • Choose a diet with plenty of vegetables, fruits, and grain products
  • Use sugar and salt/sodium only in moderation
  • If you drink alcoholic beverages, do so in moderation.

Following are some of the herbs that appear in current scientific literature that are especially beneficial for women.

Krill Oil Eases PMS Symptoms
Analysis of the interim data on an ongoing clinical study shows Neptune Krill Oil, a natural product composed of omega-3, potent phospholipids and antioxidants, works effectively on both the inflammation and pain as well as the emotional and psychological symptoms, by favorably affecting neurotransmitters within the brain.  

Evening Primrose Oil for PMS
Evening primrose seed oil, which is high in the essential fatty acid gamma-linolenic acid (GLA) is used for PMS. Over 120 studies in 15 countries have reported on potential use of primrose seed oil in imbalances and abnormalities of essential fatty acids, including PMS.1 One clinical trial showed that supplementing the diet with evening primrose oil helped to relieve PMS symptoms such as mood swings, irritability, and breast tenderness.2 Another study showed evening primrose oil treatment for PMS to be insignificant. Perhaps the truth lies somewhere in between.

Butterbur Supports Healthy Bladder Control

Women who experience urinary incontinence, probably have two of the following indicators: frequency of urination (usually defined as more than 8 times in 24 hours), urgency (an immediate and strong urge to urinate), and leaking or involuntary loss of urine.  Butterbur Extract has been shown in research to improve the sudden urge to urinate.

Dong Quai & Reproductive Balance
Dong Quai is the most widely prescribed herb in China. Dong quai means "proper order" and it helps to nourish blood, harmonize qi or vital energy, and helps the system return to proper order in cases of irregular menstruation, suppressed menstrual flow, painful or difficult menstruation, anemia, and uterine bleeding. Dong quai can both relax and stimulate uterine contractions (normalize contractions), increase blood flow to the uterus, increase red blood cell production, increase circulation, and serves as an anti-inflammatory with pain relieving effects.3

Black Cohosh & Menopause
Black cohosh preparations are approved in Germany for treating symptoms of PMS, painful or difficult menstruation, as well as aiding in symptoms of menopause, especially hot flashes. A compound in black cohosh root has been associated with estrogen-like activity, binding to estrogen receptors in the uterus. With the decline of ovarian function during menopause, estrogen is lowered and there's an increase in luteinizing-hormone production, reducing hot flashes. A clinical study found that black cohosh was comparable to conventional treatment in helping to reduce hot flashes.4,5

Soy Isoflavones
Based on results from controlled trials, dietary supplements containing soy isoflavones appear to have value in the control of menopausal symptoms. In a randomized, double blind, placebo-controlled, multicenter study, 104 postmenopausal women received soy isoflavones or placebo daily for 12 weeks. The results indicated that soy reduced the frequency of hot flashes by 45%, with a 30% reduction obtained for patients taking placebo.6,7

Long-term consumption of soy isoflavones by premenopausal women could reduce the risk of developing breast cancer. In order to reflect dietary patterns in Asia, this consumption should begin well before menopause. The value of soy isoflavones in modifying cardiovascular risk is suggested, but more research is necessary to better understand their effects.6

Dietary soy isoflavones supplementation prevented bone loss in an animal study modeling osteoporosis, but did not prevent ovariectomy-induced bone turnover in another study.8,9

Soybean protein may cause severe allergic reactions in sensitive individuals. However, the allergic reactions are less likely to occur with dietary supplements standardized to isoflavonoid content, since they contain low quantities of proteins.

Vitamins and Minerals
Vitamins and minerals are essential to a healthy diet. A well-balanced diet will usually meet women's recommended daily allowances for vitamins and minerals.. However, a multivitamin and mineral supplement will generally fill the gaps that a standard American diet may be lacking. See the Recommended Dietary Allowances which are the bare minimum amounts required to keep you from getting sick.

Calcium
Women have a greater risk than men of developing osteoporosis. Both women and men need enough calcium to build peak (maximum) bone mass during their early years of life. Low calcium intake appears to be one important factor in the development of osteoporosis.

Osteoporosis is a condition in which progressive loss of bone mass occurs with aging. Osteoporosis causes the bones to be more susceptible to fracture. If a woman has a high level of bone mass when her skeleton matures, this may reduce her risk of developing osteoporosis.

Therefore, particularly during adolescence and early adulthood, women should increase their food sources of calcium. "The most important time to get a sufficient amount of calcium is while bone growth and consolidation are occurring, a period that continues until approximately age 30 to 35," says Marilyn Stephenson, a registered dietitian with FDA's Center for Food Safety and Applied Nutrition. "The idea is, if you can build a maximum peak of calcium deposits early on, this may delay fractures that occur later in life."

The recommended dietary allowance (RDA) for calcium for woman 19 to 24 is 1,200 milligrams per day. For women 25 and older, the allowance drops to 800 milligrams, but that is still a significant amount, says Stephenson. "The need for good dietary sources of calcium continues throughout life," she says.

How do you get enough calcium without too many calories and fat? After all, the foods that top the calcium charts–milk, cheese, ice cream–aren't calorie and fat lightweights.

"There are lots of lower fat choices," says Stephenson. "There's 1 percent or skim milk instead of whole milk. There's a good variety of lower fat cheeses, yogurts, and frozen yogurts, and there's a whole flock of substitutes for ice cream."

In addition to dairy foods, other good sources of calcium include salmon, tofu (soybean curd), certain vegetables (for example, broccoli), legumes (peas and beans), calcium-enriched grain products, lime-processed tortillas, seeds, and nuts.

Iron
For women, the RDA for iron is 15 milligrams per day, 50 percent more than the RDA for men. Women need more of this mineral because they lose an average of 15 to 20 milligrams of iron each month during menstruation. Without enough iron, iron deficiency anemia can develop and cause symptoms that include pallor, fatigue and headaches.

After menopause, body iron stores generally begin to increase. Therefore, iron deficiency in women over 50 may indicate blood loss from another source, and should be checked by a physician.

Animal products–meat, fish and poultry–are good and important sources of iron. In addition, the type of iron, known as heme iron, in these foods is well absorbed in the human intestine.

Dietary iron from plant sources, called non-heme, are found in peas and beans, spinach and other green leafy vegetables, potatoes, and whole-grain and iron-fortified cereal products. Although non-heme iron is not as well absorbed as heme iron, the amount of non-heme iron absorbed from a meal is influenced by other constituents in the diet. The addition of even relatively small amounts of meat or foods containing vitamin C substantially increases the total amount of iron absorbed from the entire meal.

Calories and Weight Control
The Food and Nutrition Board of the National Research Council recommends that the average woman between 23 and 50 eat about 2,200 calories a day to maintain weight.

The best way for a woman to determine whether she's eating the right number of calories is to "keep stepping on the scale," says FDA's Stephenson.

She cautions, however, that cutting back on calories isn't always the answer to losing weight. "You don't really want to cut back any more [calories] if you're down around that [1,500 calories] range," says Stephenson. She explains that the fewer the calories you have to work with, the harder it is to meet all your daily requirements for a healthy diet.

"If you find you are gaining weight, you need to think of not only cutting calories, but also about increasing exercise," she says. "Calories are only half the equation for weight control. Physical activity burns calories, increases the proportion of lean to fat body mass, and raises your metabolism. So, a combination of both calorie control and increased physical activity is important for attaining healthy weight.

"On the other hand, if you've been pigging out–well, you know what you have to do."

Cholesterol
Women tend to have higher levels than men of a desirable type of cholesterol called HDLs (high-density lipoproteins) until menopause, leading some researchers to believe there is a link between HDLs and estrogen levels. But this doesn't let women off the hooka diet high in saturated fat and cholesterol can still mean trouble.

For both women and men, blood cholesterol levels of below 200 milligrams are desirable. Levels between 200 and 239 milligrams are considered borderline, and anything over 240 milligrams is high. High levels of blood cholesterol increase the risk of coronary heart disease.

To keep levels in the good range, the National Cholesterol Education Program of the National Heart, Lung, and Blood Institute recommends eating no more than 300 milligrams of cholesterol a day. Cholesterol is found only in food from animal sources, such as egg yolks, dairy products, meat, poultry, shellfish, and--in smaller amounts--fish and some processed products containing animal foods.

Even more important than limiting cholesterol to under 300 milligrams is keeping saturated fat to under 10 percent of total calories, says Nancy Ernst, the nutrition coordinator for the National Heart, Lung, and Blood Institute.

"Don't even think about cholesterol in your diet," says Ernst. "Focus on reducing saturated fat."

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Fat
In the United States, out of every 100,000 women, approximately 27 die from breast cancer each year. In Japan, breast cancer deaths are fewer than 7 per 100,000. Some scientists think that the difference in death rates may be related to the different amounts of fat in the average diet in each country–40 percent for American women versus 20 percent in Japan.

"We believe pretty strongly in the link [between high-fat diets and breast cancer]," says Jeffrey McKenna, director of NCI's Cancer Awareness Program.

Population studies have also linked high-fat diets to other cancers, particularly colorectal cancer.

Fat does, however, serve a purpose in the diet. Fats in foods provide energy and help the body absorb certain vitamins. But it is as easy as pie (and doughnuts, ice cream, and sirloin steaks) to eat too much.

For a healthy diet, the diet and health report of the National Research Council recommends reducing fat to no more than 30 percent of total calories. But that's not all. In terms of heart disease, the kinds of fat you eat are as important as how much.

There are three kinds of fat–saturated, polyunsaturated and monounsaturated. All three are equal when it comes to calories–9 per gram (compared to 4 calories per gram for protein or carbohydrate). But they aren't equal when it comes to how they affect your health.

More than anything else in the diet, saturated fat can raise your blood cholesterol level. Because of this risk, less than one-third of your daily fat intake (less than 10 percent of total calories) should come from saturated fats.

That's the bad news. The good news is polyunsaturated and monounsaturated may actually lower blood cholesterol levels. The diet and health report recommends that not more than 10 percent of total calories should be from polyunsaturated fat, and monounsaturated fat should make up the remaining 10 percent.

The foods with the highest amounts of saturated fat come from animals–meat, of course, and foods derived from animals, such as butter, cream, ice cream, and cheese. In addition to animal products, coconut and palm kernel oils are very high in saturated fat–over 90 percent.

The best sources for polyunsaturated fats are plant-based oils–sunflower, corn, soybean, cottonseed, and safflower. Monounsaturated fats are found in the largest amounts in olive, canola and peanut oils.

Fiber
An apple a daythat is, a whole apple with the skinwill give you approximately 3.6 grams of fiber. That's a good start, but you still need a lot more fruits, vegetables, and whole grains to meet the daily level of 20 to 30 grams of fiber recommended by the National Cancer Institute.

Eating foods with plenty of complex carbohydrates and fiber (vegetables, fruits, and grain products) is part of a healthy diet for several reasons. A fiber-rich diet is helpful in the management of constipation and may be related to lower rates of colon cancer. These types of foods are generally low in fat and can be substitutes for fatty foods.

Fiber comes in two forms--insoluble and soluble. Insoluble fiber, mostly found in whole-grain products, vegetables and fruit, provides bulk for stool formation and helps move wastes more quickly through the colon. Another benefit is the full feeling fiber may create in the stomach, a possible deterrent to overeating.

Soluble fiber has been linked to lowering blood cholesterol levels, but that's still a research area according to the Surgeon General's Report on Nutrition and Health. There are many sources of soluble fiber, including peas and beans, many vegetables and fruits, and rice, corn and oat bran. There are even small amounts in pasta, crackers, and other bakery products.

Although foods containing fiber seem to exert a protective effect against some cancers, the diet and health report points out there is no conclusive evidence that dietary fiber itself, rather than other components, exerts this effect. Therefore, the report does not recommend the use of fiber supplements.

As important as fiber is to good health, it can be overdone. NCI recommends an upper limit of 35 grams a day. More probably won't further increase the benefits from fiber, and may interfere with the body's ability to absorb iron and other minerals.

When increasing the amount of fiber in your diet, do it slowly, so your body can become accustomed to handling it. Adding too much fiber too quickly may lead to uncomfortable side effects, including abdominal discomfort, flatulence and diarrhea.

Menopause

Menopause is when a woman's menstrual periods stop altogether and a woman is said to have gone through menopause when her menstrual periods have stopped for an entire year. This usually occurs between the ages of 45 and 55, although it can happen as early as 35 or as late as 65 years of age. It can also result from the surgical removal of both ovaries. The physical and emotional signs and symptoms that go with menopause usually last around one to two years or more, and vary from woman to woman. The changes are a result of hormonal changes such as estrogen decline, the aging process itself, and stress.

The physical signs and symptoms associated with menopause may include hot flashes, heart palpitations, irregular periods, vaginal dryness, loss of bladder tone, headaches, dizziness, skin and hair changes, loss of muscle strength and tone, and decreased bone mineral density. Emotional changes associated with menopause may include irritability, mood changes, lack of concentration, difficulty with memory, tension, anxiety, depression and insomnia.

Hormone replacement therapy (HRT) is often used to reduce many of the symptoms of menopause. It also offers significant protection against osteoporosis and heart disease. However, it may increase the risk of certain types of cancer and some women are unable or unwilling to use HRT.

Regular exercise and stress reduction techniques can be helpful in reducing the symptoms of menopause. Dietary measures that may be beneficial include limiting or avoiding drinks that contain caffeine or alcohol, spicy foods, and heavy meals. Soy foods such as tofu, which contain compounds known as phytoestrogens, have been shown to reduce menopausal symptoms in many women. A woman's risk of disorders such as heart disease and osteoporosis increases after menopause, and the various dietary measures and supplements outlined above can be used to prevent these.

Dori Stehlin is a staff writer for FDA Consumer.

National Academy of Sciences/National Research Council
Recommended Dietary Allowances for Women Age 19 to 50 (1989)

Vitamins
Vitamin A: 800 micrograms
Vitamin D: 10 micrograms (age 19 to 24), 5 micrograms (age 25 to 50)
Vitamin E: 8 milligrams
Vitamin K: 60 micrograms (19 to 24), 65 micrograms (25 to 50)
Vitamin C: 60 milligrams
Thiamine: 1.1 milligrams
Riboflavin: 1.3 milligrams
Niacin: 15 milligrams
Vitamin B6: 1.6 milligrams
Folate: 180 micrograms
Vitamin B12: 2 micrograms

Minerals
Calcium: 1,200 milligrams (19 to 24), 800 milligrams (25 to 50)
Phosphorus: 1,200 milligrams (19 to 24), 800 milligrams (25 to 50)
Magnesium: 280 milligrams
Iron: 15 milligrams
Zinc: 12 milligrams
Iodine: 150 micrograms
Selenium: 55 micrograms

Figure Out Your Fat Intake
The recommendation is that no more than 30 percent of total calories come from fat. Food labels list fat in grams. To find out what your total intake of fats in grams should be limited to, multiply your daily calories by 0.30 (30 percent) and divide by 9 (the number of calories in a gram of fat).
Example
2,200 calories times 0.30 = 660 calories from fat
660 calories divided by 9 = 73 grams of fat

References

  1. Foster S. Herbs for Your Health. Loveland, Colorado: Interweave Press, 1996
  2. Khoo SK, et al. Evening Primrose Oil and Treatment of Premenstrual Syndrome. Medical Journal of Australia; 1990; 153: 189-192.
  3. Tyler V. Herbs of Choice. Binghampton, New York: Pharmaceutical Products Press, 1994.
  4. Hobbs C. Vitex: The Women's Herb. Capitola, California: Botanica Press, 1990
  5. Shrimp LA, Fleming CM. Vaginal and Menstrual Products. Handbook of Nonprescription drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  6. Bone K. Soy Isoflavones: a review of their influence on women's health. Townsend Letter for Doctors & Patients; Jan 2000.
  7. Albertazzi P, Pansini F, Bonaccorsi G, et al. Obstet Gynecol 1998; 91(1); 6-11.
  8. Arjmandi BH, Alekel L, Hollis BW et al. Journal of Nutrition 1996; 126 (1); 161-167.
  9. Lees CJ, Ginn TA. Calcif Tissue Int 1998; 62; 557-558. Article adapted with permission from Stehlin D. Women and Nutrition: A Menu of Special Needs. FDA Consumer; May, 1995.

Article adapted with permission from Stehlin D. Women and Nutrition: A Menu of Special Needs. FDA Consumer; May, 1995.
U.S. Food and Drug Administration

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