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    Features

    Closing the Gap in Women’s Health with Evidence-Based Supplements

    Shedding stereotypes and stigma, women are leading a revolution in healthcare.

    Closing the Gap in Women’s Health with Evidence-Based Supplements
    rawpixel.com/adobe.stock.com
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    By Sean Moloughney, Editor06.03.24
    In November 2023 the Biden Administration established the first White House Initiative on Women’s Health Research within the Office of the First Lady, aiming to change how we approach and fund women’s health research.
     
    “Beyond the immediate health consequences, underinvesting in women’s health research can decrease women’s well-being and quality of life, hold women back in the workplace, and affect their families’ economic security,” the White House said. “By contrast, increasing investments in women’s health research can yield broad societal gains, including lower health care costs and a more productive and inclusive workforce.”
     
    In February this year, First Lady Jill Biden announced $100 million in federal funding for research and development into women’s health as part of the new initiative. Money comes from the Advanced Research Projects Agency for Health (ARPA-H), which is under the Department of Health and Human Services.
     
    During his State of the Union speech in March, President Biden called on Congress to make a $12 billion investment in funding for women’s health research.
     
    Biden also signed an executive order in March that includes, among other projects, an NIH-wide effort to close gaps in women’s health research across the lifespan. That effort will be supported initially by $200 million from NIH beginning in FY 2025. 

    Representation in Research

    Pelin Thorogood, co-founder and executive chair of Radicle Science, which conducts clinical trials on supplements and natural products, said the White House efforts signal a “much-needed commitment from the government to address the unique health needs and challenges faced by women.”
     
    “It has the potential to drive significant progress in advancing women’s health outcomes and promoting gender equity in healthcare,” she added. “Even if it’s not perfect, it’s certainly a step in the right direction, and depending on how we seize the opportunities provided, it has the power to drive significant progress.”
     
    Despite making up about half of the population, women are “hugely underrepresented in clinical research,” said Holly Johnson, chief science officer at the American Herbal Products Association (AHPA).
     
    “In fact, an FDA ban on most women of reproductive age from participating in clinical research studies was not formally lifted until 1993,” she added. “With the recent executive order and investment into advancing women’s health research, we would expect to see increased research attention on health conditions that exclusively affect women, such as menstruation, pregnancy, fertility, and menopause. In addition, we hope for increased inclusion of women in research on health conditions that affect both men and women, such as cardiovascular disease.”
     
    Even though nearly one in three women will die of a heart-related condition, diagnosis is frequently missed or delayed in women since their symptoms often differ from those seen in men. Women are 50% more likely to be misdiagnosed following a heart attack and, according to the American Heart Association, less than half of all primary care doctors and cardiologists say they feel “extremely well prepared” to assess women’s cardiovascular risks, highlighting the need to improve awareness of diagnostic protocols among healthcare providers and expand access to heart health monitoring tools to all women. 
     
    “More work is needed to ensure that clinical trials include diverse populations and consider gender differences in study design and analysis,” said Thorogood. “Once we overcome this primary limitation, we have the opportunity to work on a plethora of women’s health issues that are long overdue for rigorous clinical research,” like cardiovascular disease (CVD).
     
    “More research is needed to understand the unique risk factors, symptoms, and treatment approaches for heart disease in women,” she added.


    Photo: Mego-studio/adobe.stock.com

    Driving Progress

    While moderating a panel discussion on women’s health and the role of brands at Natural Products Expo West in March, Sara Gragnolati, director of innovation at MegaFood, noted that, as of 2020, beyond oncology, “only 1% of healthcare research and innovation was invested in female-specific conditions. Female-dominant diseases are funded at half the level of male-dominant diseases. Historically, women’s health has been underfunded and under-researched.”
     
    Women also make 80% of consumer purchasing decisions in healthcare, equivalent to an estimated $2 trillion in annual healthcare spending, said Gragnolati. “However, until about 30 years ago, women were excluded from NIH-funded clinical trials because of fluctuating hormones and the possibility that they would become pregnant during research.”
     
    As a result, “women are twice as likely as men to experience adverse events from drugs. And even though heart disease is the leading cause of death among women, only 38% of cardiovascular disease trial participants are women. Historically, women’s health has been underserved and oversimplified.”
     
    Along with additional research, Dr. Tieraona Low Dog, MD, physician, author, and educator, said during the women’s health education session that there needs to be a “cultural shift within medicine,” and society at large, to understand and trust women when it comes to their health.
     
    “Women with heart disease typically have what we call microvascular disease, which means their angina, or chest pain, typically happens at rest or with routine activity,” Low Dog explained. “Men’s angina typically happens with more exertion and physical exercise.”
     
    Too often, when women seek care for chest pain they are dismissed, especially by male physicians, she added. “A woman comes into the emergency room and complains about chest pain, 31% of women who actually then go on to have a cardiac event were actually discharged with a psychiatric medication,” compared to about 14% of men, Low Dog said.
     
    “By directly addressing gender bias in research,” Thorogood said, “we can take a giant step forward in our understanding of women’s health issues. And we can finally start developing more effective prevention and treatment strategies that are specific to women.”
     
    “To drive progress,” she added, “the nutraceuticals industry must acknowledge that women have distinct physiological, psychological, and social characteristics ...  We need to formulate products based on research specific to women’s physiology, substantiated by randomized controlled trials conducted on female participants across different life stages.”


    “The time is way past for us to think of women’s health as more than reproductive health. If we limit it to our reproductive health it diminishes in every way our experience and our health burden.”
    — Dr. Tieraona Low Dog, MD


    The Women-Led Health Revolution

    Coinciding with additional research, Low Dog advocated for an education campaign to communicate what science and traditional historic use have already revealed. There needs to be an initiative to ensure “women are well educated about their own health and symptoms so that they recognize issues and advocate for themselves.”
     
    Until recently, the women’s health category for dietary supplements was divided into three segments: general health, prenatal, and menopause. But that’s beginning to evolve.
     
    “The good news is our industry has been taking notice and change is underway,” said Gragnolati. “Women’s health needs are more nuanced than just these sectors and cohorts.”
     
    An estimated 80% of women use dietary supplements weekly, and when polled, 69% of women say they’re more likely to take a supplement specifically designed for them, said Gragnolati.
     
    “We’re at a precipice of not just an evolution, but a revolution in women’s health supplements,” she said. “Historically, women have not had a fair shot, but they’re taking matters into their own hands.”
     
    “The time is way past for us to think of women’s health as more than reproductive health,” said Low Dog. “If we limit it to our reproductive health it diminishes in every way our experience and also our health burden.”
     
    Women need broad, rational, and effective health solutions that are informed by research and historical use, said Low Dog.
     
    According to a 2024 report from McKinsey & Company, “Addressing the 25 percent more time that women spend in ‘poor health’ relative to men not only would improve the health and lives of millions of women but also could boost the global economy by at least $1 trillion annually by 2040. This estimate is probably conservative, given the historical underreporting and data gaps on women’s health conditions, which undercounts the prevalence and undervalues the health burden of many conditions for women.”
     
    Kate Jamieson, vice president of e-commerce and marketing at Bonafide Health, which offers products for relief of menopause symptoms, said there’s been a “generational shift in the prioritization of health.”
     
    “For our brand, it’s important for us to understand these generations’ purchasing behaviors,” she added. “How do they want to engage on digital (platforms)? And how can brands interact with these customers?”
     
    The attention to women’s health is “exciting,” she continued. “It’s such a powerful discussion to be having, and I only see opportunity for women’s health supplements moving forward.”


    Photo: dusanpetkovic1/adobe.stock.com

    Shedding Stigmas

    In his 1966 book Feminine Forever, American gynecologist Robert A. Wilson characterized menopause as a disease state and advocated for the use of hormone therapy to alleviate symptoms. That diagnosis has had broad, long-lasting implications. 
     
    “We pathologize everything in women,” said Low Dog. “I want us in the supplement space to recognize that we are uniquely positioned to help women move through transitions, through their life stages, in a way that optimizes her health and her health span without going down the pharma route.”
     
    The relationship between doctor and patient needs to evolve as well, Low Dog reiterated. “A woman who comes into the ER and is treated by a male physician is ... far less likely to be admitted for chest pain, also PCOS (Polycystic ovary syndrome). A woman who comes in with abdominal pain will wait, on average, 20 minutes longer than a male with the same type of pain to receive any sort of pain medication.”
     
    Low Dog urged women to assess if their healthcare provider is truly partnering with them. If not, “then you need a new one.”
     
    The 1960s civil rights movement was driven by minorities and women who demanded more from their society, said Low Dog. “I think that’s what we’re seeing today.” Recognition of the injustice of underrepresentation in research,  and the White House’s course correction are the net effect of demands from women and minority groups.
     
    Since women have been excluded from clinical research, there’s not much evidence in Pubmed or the National Library of Medicine on women’s health issues, said Low Dog. “Think how much smaller that pool is for dietary supplements or botanicals.”
     
    As a result, an “evidence-informed” approach is warranted, she added. “Botanicals have been used for thousands and thousands of years. There’s indigenous wisdom and science, traditional wisdom, thousands of years of materia medica in India, China, and other places.” So when it comes to “evidence” we should all “think more inclusively,” Low Dog said.
     
    “Let’s be honest, no one ever died from menopause, but you can die from some of the treatments that have been used for menopause,” she noted, adding that women deserve therapies, products, supplements, and botanicals that are safe and effective.
     
    Holly Johnson at AHPA agreed that many botanicals “have been used safely for years to address conditions that affect women.”
     
    “Increased research on the use of botanicals in women’s health could serve to increase overall consumer confidence in the benefits of botanicals on personal health,” Johnson said.
     
    Despite a history of neglect, Low Dog is “very optimistic” about the future of research in women’s health. “Whatever you think about artificial intelligence, its ability to collate and analyze data ... is pretty phenomenal.”

    Education & Awareness

    There are as many as 34 different symptoms of menopause, noted Jamieson at Bonafide. “For us, it’s challenging to educate women about menopause in this diverse area. “Considering half the population is going to go through menopause,” the topic deserves more open discussion, and solutions should be more prominent at retail.
     
    Many women in their 30s and 40s who are entering perimenopause “don’t want anything to do with menopause because the stigma right now is that menopause means you’re getting old,” said Jamieson.
     
    “We found a majority of women don’t know how early the symptoms of menopause can start, and when they have their first symptom they blame it on something else. They’re not connecting the dots back to menopause and they end up suffering with their symptoms.”
     
    “One of our core beliefs at Bonafide is that proactive education helps women find solutions sooner and get relief faster ... How can we help her connect the dots sooner to end her needless suffering?”
     
    According to Gragnolati, only one in four women feel they are very knowledgeable about gynecological and reproductive health. “Less than 30% are aware of what to expect when entering menopause, and nearly half of women agree there’s a need for better education on women’s health overall.”
     
    Additionally, only 25% of women believe their physician is very knowledgeable in areas of women’s health. However, 75% of women get their health information from doctors. So how can industry help bridge that gap?
     
    “The need for different communication styles targeting women vs. men cannot be overstated,” said Thorogood. “As such, marketing messages should be crafted to resonate with women’s unique communication preferences and communicated via the right mediums (remembering Negroponte’s famous line that ‘the medium is the message’).”
     
    “I’ve spent most of my adult career educating physicians,” said Low Dog. “I think doctors are hungry for it. There’s a lot of skepticism in the medical community around supplements. They only hear about the bad stuff, like adulteration, instead of learning about how to help their patients find reputable supplements.”
     
    Only one in five women between the ages of 40 and 60 say that a doctor even talked about menopause, Low Dog noted. Having that conversation is important. Also, a third of women go through menopause without any symptoms, so reassuring women that the floor won’t fall out from underneath them can ease some concerns.
     
    “There’s a whole range of clinically tested and evidence-informed types of products available,” said Low Dog. “If those things are not enough for you then there’s also hormones and other things that you can use. Women are individuals and there’s a whole range of options. These brands are putting together products that can help you in these transitions.”
     
    Vivian Rhoads, president of the Women’s Health Business Unit for Pharmavite, which includes Uqora and Equelle, urged companies to “stay focused on the truth, and meet people where they are.”
     
    “That’s the magic of education, especially in women’s health, where there’s a lot of stigma. You need to connect with people in a truthful way and enable connections. That’s what Uquora has done very effectively.” The brand has a Facebook community group, The Uquora Collective, with about 22,000 active members, said Rhoads.
     
    “It’s not really about urinary care, it’s about quality of life ... You can make a big difference by giving them access to information.”
     
    Misinformation around menopause makes it hard for brands to break through the clutter, she admitted, especially with supplements, which often take time to work. 
     
    “There are a lot of brands in the supplement space that are really invested in producing safe, effective, high-quality products,” said Jamieson. “But unfortunately there’s a lot of other supplements on the market that have shiny marketing, maybe not great claims, they’re not effective ... and they cloud the entire environment for all of us.”
     
    “We spend $2 million a year on R&D and new product development,” she added. “We’ve got 20 different clinical studies ... completed or running. It’s such a key pillar of our business. I hope that the rest of the industry can hold onto that, and make change that way.” 


    About the Author: Sean Moloughney has been the editor of Nutraceuticals World since 2012. He can be reached at smoloughney@rodmanmedia.com.

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