The six essentials that women need more of are:
- B vitamins – especially vitamin B6, folic acidWhat it does: Critical during pregnancy for the development of a baby’s brain and nerves. Also essential for brain and nerve function. Needed for utilising… and B12
- Vitamin CWhat it does: Strengthens immune system – fights infections. Makes collagen, keeping bones, skin and joints firm and strong. Antioxidant, detoxifying pollutants and protecting against…
- MagnesiumWhat it does: Strengthens bones and teeth, promotes healthy muscles by helping them to relax, also important for PMS, important for heart muscles and nervous…
- ZincWhat it does: Component of over 200 enzymes in the body, essential for growth, important for healing, controls hormones, aids ability to cope with stress…
- IsoflavonesIsoflavones are naturally occurring compounds – many act as phyto-oestrogens. An example of an isoflavone is Soya Isoflavones….
- Indoles eg I3C
B vitamins are important both for the production of energy and stabilizing mood. B6 is needed to convert essential fats into prostaglandins, which sensitise cells to hormones and therefore prevent the effects of hormone imbalances.
Vitamin B6 is needed for choline to function which helps to clear oestrogens from the liver. If these oestrogens are not cleared efficiently, symptoms related to oestrogenOestrogen is one of the main female sex hormones…. overload may occur, including greater risk of breast cancer.
A low level of B6 is associated with an excess of oestrogen in relation to progesteroneProgesterone is one of the main female sex hormones…. so supplementing with the vitamin will help to restore the balance. It has also been shown that vitamin B6 levels are depleted in women taking the contraceptive pill, likely to be due to the additional supply of oestrogen. Several trials on vitamin B6 have reported considerable improvements in premenstrual syndrome, usually at a dose of 100mg a day (1). B6 alleviates depression associated with premenstrual syndrome (2). Also, premenopausal women in the top third for B6 levels cut their risk for breast
cancer by a third. (30)
Vitamins B12 and folic acid are also co-factors for the enzymes that either synthesise hormones or help to create prostaglandins. Together with B6 they are the cornerstone of methylationMethylation is what occurs when the body takes one substance and turns it into another, so that it can be detoxified and excreted from the…, which protects DNA, hence doubly essential in pregnancy to minimise risk of pregnancy problems and birth defects. But methylation also helps switch off genes that predispose to disease.
In order for your body to convert B6 (as pyridoxine) into its active form (pyridoxal-5-phosphate), which your body can use, it needs other nutrients such as zinc and magnesium. Giving vitamin B6 elevates magnesium levels during periods (3). Low magnesium levels are associated with poor appetite, nausea, lethargy, mood swings and muscle cramps. Magnesium reduces water retention (4) and improves mood (5).
Women suffering from PMS have been shown to have lower levels of magnesium compared to women without symptoms. Oestrogen increases tissue and bone absorption of magnesium, thus, ageing (decreasing oestrogen) is associated with increased need for magnesium (and higher rates of magnesium deficiency conditions) (6).
Like vitamin B6 and zinc, magnesium is required for making prostaglandins, and may help PMS sufferers this way. Cramps are most commonly due to calciumWhat it does: Promotes a healthy heart, clots blood, promotes healthy nerves, contracts muscles, improves skin, bone and dental health, relieves aching muscles and bones,…/magnesium imbalances and can be corrected by supplementing with magnesium.
The combination of vitamin B6 with magnesium is particularly effective in reducing the symptoms of PMS. A randomised controlled study gave three groups of women either a placebo, magnesium on its own or with vitamin B6 for four months. (You want to be taking in about 50mg of B6 and 300mg of magnesium for a significant effect.) The mean score of PMS significantly decreased in all the three groups (p < 0.05). The decrease was the greatest in the Mg plus vitamin B6 group, and was the least in the placebo group (7).
Magnesium has so many other benefits, including muscle relaxation, lowering blood pressure, preventing insomnia and generally calming emotions and promoting mood. Vitamin B6 and magnesium improve anxiety related PMS (8).
Having a low magnesium level, especially pre-menstrually, may also be a risk factor for headaches and migraines. One recent study found that, among migraine sufferers, the odds of having a migraine increased by 36 times when magnesium levels dropped below normal levels (9). Another reviewed 10 studies giving high dose oral magnesium and 11 giving intravenous magnesium, both of which showed a dramatic and significant relief of symptoms (10). Most studies gave 1,000mg of magnesium.
Getting enough magnesium also reduces cancer risk. A high magnesium intake almost doubles survival from breast cancer (11). A recent massive study of 140,000 women followed for 13 years found that those in the highest fifth of magnesium intake, equivalent to 400mg a day, cut their risk of colorectal cancer by 20 per cent (12).
However, achieving 400mg of magnesium from diet is no small feat. The average woman achieves almost half this – 226mg a day. That is why I think it is essential for a woman to supplement at least an extra 200mg which is the minimal dose in studies that produces an effect. My multi gives 155mg if taken twice a day, which is exceptional for multivitamins. However, you want an extra 50 to 100mg, especially if you have PMS or menopausal symptoms.
The mineral zinc plays an important role in fertility and reproduction and is one of the key nutrients you want to bump up if pregnant or breastfeeding. It’s also an important co-factor in female hormone production and much needed pre-menstrually and post-menopause.
Zinc and magnesium levels tend to be lower in PMS sufferers, especially in the luteal phase, before a period. Both appear to boost serotoninSerotonin is a hormone found naturally in the brain and digestive tract. It is often referred to as the ‘happy hormone’ as it influences mood…. levels and zinc has an anti-depressant effect (13). Zinc is vital for methylation, working with B vitamins and betaine hydrochloride (stomach acid).
There are over 150 enzymes in the body dependent on zinc and many are connected with hormonal balance. Most women don’t get enough with the average intake being 7.6mg. I’d say a minimum intake is 15mg but you can easily double this if you have hormonal or fertility issues and wish to get pregnant. A good multi might give you 10mg so you could do with the same again from a female friendly formula like my Female Balance available from Holfordirect.com.
We all need vitamin C, and few get enough. At the very least one wants to take in 1,000mg although I believe a good average optimum level is twice this. However, women could do with a little more, especially later in life. Oestrogen deficiency, seen during the menopause is associated with increased cardiovascular risk and endothelial dysfunction, which means that arteries, and skin, become less elastic. This leads to higher blood pressure and more wrinkles, respectively. Antioxidants such as vitamin C have been shown to improve endothelial function in healthy oestrogen-deficient postmenopausal women (14). A study in 2005 also found that ascorbic acid (vitamin C) infusion increased arterial compliance by 25% in postmenopausal women (15).
Vitamin C also helps B vitamins, such as B6, and magnesium to work. These also help the body to use essential fats, which are the seventh essential for women (and men). A major review of studies testing nutrients and their effects on stress in women concludes that essential fats may be effective in reducing prenatal stress and salivary cortisolCortisol has been nicknamed ‘the stress hormone’ as it is released in higher levels during the body’s flight or fight response to stress. Levels of… and may reduce anxiety during premenstrual syndrome and during menopause in the absence of depression.
Magnesium and vitamin B6 may be effective in combination in reducing premenstrual stress, and vitamin B6 alone may reduce anxiety effectively in older women. High-dose sustained-release vitamin C may reduce anxiety and mitigate increased blood pressure in response to stress (16).
These oestrogen-like, plant-derived substances are found in high amounts in soy products and red clover. Many women are confused, seeing the word ‘oestrogen’ and therefore think anything containing phytoestrogens must be bad. But they actually protect against oestrogen overload by occupying the same hormone receptor sites as oestrogen.
Numerous studies of populations have shown there to be a link between diets high in isoflavones, usually from soy, and reduced experience of menopausal symptoms, PMS and breast cancer. Four studies found that isoflavone supplementation approximately halved the incidence and severity of hot flushes (17). While other studies have not found significant effects, they have shown that the higher the isoflavone levels in the urine of the women studied, the lower the incidence of hot flushes (18). The most recent study in 2017 found that women given 100mg of isoflavones had less hot flushes and imporvements in psychological symptoms. (31) In addition to this, isoflavones have been shown to protect against cancer, and a review of evidence by the Committee on Toxicology (COT), part of the UK’s Food Standards Agency, also indicated that phyto-oestrogens protect against breast cancer.
In one study the higher the isoflavone intake the lower the PMS scores (19). In another randomised controlled trial, soya proteinProteins are large molecules consisting of chains of amino acids. Proteins are essential nutrients for the human body – they are a building block of… (high in isoflavones) versus milk protein as a placebo, reduced PMS scores and specifically headaches and breast tenderness (20).
Red clover contains several phytoestrogens, including the isoflavones daidzein and genistein and it has been suggested that it may exert oestrogen-like effects. A recent trial found after 4 weeks of supplementation with red clover (80mg/day), hot flushes were reduced by almost a half (21).
Isoflavones also reduce the incidence of depression. Out of 20 intervention studies, reviewed last year, roughly half found statistically significant reductions in depressive symptoms in response to isoflavones. Of those studies reporting a lack of antidepressant effects of isoflavones, design limitations likely contributed to the lack of efficacy (22).
Isoflavones also improve blood lipidFats, oils, waxes and sterols are collectively known as lipids…. profile glucose (23) metabolismMetabolism is a term that is used to describe the chemical reactions that take place within the body’s cells. The body gets the energy it… and associated inflammation and thus, metabolic syndrome (24,25) , and prevent an increase in abdominal fatThere are many different types of fats; polyunsaturated, monounsaturated, hydrogenated, saturated and trans fat. The body requires good fats (polyunsaturated and monounsaturated) in order to… in post-menopausal women (26).
A recent review of 23 randomised controlled trials concludes that isoflavones probably have beneficial effects on bone health in menopausal women and probably prevent the reduction in bone mass density associated with osteoporosis and maintain a healthy bone structure during menopause (27).
DIM (Diindolylmethane) and Indole-3-carbonol
DIM and I3C contain indoles, which are plant compounds with health promoting properties. They are found in high amounts in cruciferous vegetables such as broccoli, cauliflower and cabbage. However, you would need to eat a huge amount of raw vegetables for a beneficial effect.
They have been shown to reduce the effects of oestrogen, probably due to helping the detoxification of oestrogen in the liver, and work synergistically with the isoflavone daidzein (28). DIM increases oestrogen metabolism, which results in an increase of beneficial oestrogen metabolites and a decrease in the active oestrogen, which causes problems such as weight gain, PMS and menopausal symptoms.
Epidemiological studies have also indicated that human exposure to indoles through cruciferous vegetable consumption may decrease cancer risk (29) . This is due to a reduction in the oestrogen metabolites which are responsible for the cancer initiating and cancer promoting effects of oestrogen. These oestrogens have a negative impact by allowing oxidation of cells, damage of DNA, and the promotion of cancer.
I prefer to give indole-3-carbonol (I3C) which is converted by betaine hydrochloride, into DIM. So look for supplements that provide both I3C and betaine hydrochloride together. One head of cabbage contains approximately 1200mg of (I3C), although daily dietary intake of I3C is typically 20-120mg (30). You really want at least double this so its worth supplementing 100mg as well as eating cruciferous foods.
So, in summary, I recommend all women top up their daily multivitamin and mineral, plus essential omega supplements and extra vitamin C, as in my daily Optimum Nutrition Pack with a female friendly formula providing extra:
- Vitamin B6, folic acid and B12 – 25-50mg; 133 to 266mcg; 5 to 10mcg respectively
- Vitamin C – 50 to 100mg (on top of 1-2grams)
- Magnesium – 100 to 200mg (on top of 150mg in a multi)
- Zinc – 7.5 to 15mg (on top of 10mg in a multi)
- Isoflavones – 80 to 160mg
- Indoles eg I3C – 50 to 100mg with betaine hydrochloride
Look for female friendly formulas that contain all these.
- Brush M et al Pyridoxine in the treatment of premenstrual syndrome: a retrospective survey in 630 patients. Br J Clin Pract. 1988 Nov;42(11):448-52.; K.Wyatt et al BMJ 1999, 318 : 1375; Sharma P et al, Ind. J. Physiol.Pharmacol.
- Doll H et al., Pyridoxine (vitamin B6) and the premenstrual syndrome: a randomized crossover trial. J R Coll Gen Pract. 1989 Sep;39(326):364-8.
- Abraham GE et al: Effect of vitamin B-6 on plasma and red blood cell magnesium levels in premenopausal women.Ann Clin Lab Sci. 1981 Jul-Aug;11(4):333-6.
- Walker et al, J Womens Health 1998
- Facchinetti, F et al, Obstet Gynecol. 1991
- Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome. J Am Coll Nutr. 1993 Aug;12(4):442-58.
- Fathizadeh N et al., Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5.
- De Souza MC et al., A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med. 2000 Mar;9(2):131-9.
- Assarzadegan, F. et al. Serum concentration of magnesium as an independent risk factor in migraine attacks: a matched case-control study and review of literature. Int Clin Psychopharmacol. 2016 Sep;31(5):287-92.
- Chiu, H.Y. et al. Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis of Randomised Controlled Trials. Pain Physician. 2016 Jan;19(1):E97-112.
- Tao MH, Associations of intakes of magnesium and calcium and survival among women with breast cancer. Am J Cancer Res. 2015 Dec 15;6(1):105-13. eCollection 2016.
- Gorczyca AM et al., Association between magnesium intake and risk of colorectal cancer among postmenopausal women. Cancer Causes Control. 2015 Dec;26(12):1761-9.
- Siwek M et al., J Affective Disorders 2009
- McSorley PT et al.,Vitamin C improves endothelial function in healthy estrogen-deficient postmenopausal women.Climacteric. 2003 Sep; 6(3): 238-47.
- Moreau KL et al., Ascorbic acid selectively improves large elastic artery compliance in postmenopausal women. HypertensionHypertension is more commonly known as high blood pressure….. 2005 Jun;45(6):1107-12.
- McCabe D et al., The impact of essential fatty acid, B vitamins, vitamin C, magnesium and zinc supplementation on stress levels in women: a systematic review. JBI Database System Rev Implement Rep. 2017 Feb;15(2):402-453. doi: 10.11124/JBISRIR-2016-002965.
- Tice JA et al. Phytoestrogen supplements for the treatment of hot flashes. The isoflavone clover extract (ICE) study: A randomized controlled trial. Journal of the American Medical Association, vol 290 (2) 2003 pp 207-14.
- ‘Treatment of menopause-associated vasomotor symptoms: position statement of the North American Menopause Society. Menopause, vol.11 (1) 2004 pp11-33.
- Kim H et al. Nurs Health Sci, 2006
- Bryant M et al., Effect of consumption of soy isoflavones on behavioural, somatic and affective symptoms in women with premenstrual syndrome. Br J Nutr. 2005 May;93(5):731-9.
- van de Weijer PH, Barentsen R. Isoflavones from red clover (Promensil) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas. 2002 Jul 25;42(3):187-93.
- Messina M1, Gleason C. Evaluation of the potential antidepressant effects of soybean isoflavones.Menopause. 2016 Dec;23(12):1348-1360.
- Evans M et al., Effect of soy isoflavone protein and soy lecithin on endothelial function in healthy postmenopausal women. Menopause. 2007 Jan-Feb;14(1):141-9.
- Azadbakht L et al., Soy inclusion in the diet improves features of the metabolic syndrome: a randomized crossover study in postmenopausal women. Am J Clin Nutr. 2007 Mar;85(3):735-41.
- Azadbakht L et al., Soy consumption, markers of inflammation, and endothelial function: a cross-over study in postmenopausal women with the metabolic syndrome. Diabetes Care. 2007 Apr;30(4):967-73.
- Sites CK et al., Effect of a daily supplement of soy protein on body composition and insulinInsulin is a hormone made by the pancreas. It is responsible for making the body’s cells absorb glucose (sugar) from the blood…. secretion in postmenopausal women. Fertil Steril. 2007 Dec;88(6):1609-17.
- Abdi F et al., Effects of phytoestrogens on bone mineral density during the menopause transition: a systematic review of randomized, controlled trials. Climacteric. 2016 Dec;19(6):535-545.
- Auborn KJ et al., Indole-3-carbinol is a negative regulator of estrogen. J Nutr. 2003 Jul;133(7 Suppl):2470S-2475S.
- Higdon JV et al., Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacol Res. 2007 Mar;55(3):224-36. Bell M C et al. Placebo-controlled trial of indole-3-carbinol in the treatment of CIN. Gynecol Oncol 2000; 78:123-9.
- Agnoli C et al.,Plasma Riboflavin and Vitamin B-6Associated with Breast Cancer Risk in the European Prospective Investigation into Cancer and Nutrition-Varese Cohort.J Nutr. 2016 Jun;146(6):1227-34
- Ahsan M, Mallick A et al.,The Effect of Soy Isoflavones on the Menopause Rating Scale Scoring in Perimenopausal and Postmenopausal Women: A Pilot Study.J Clin Diagn Res. 2017 Sep;11(9):FC13-FC16.
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