The six essentials that women need more of are:
- B vitamins – especially vitamin B6, folic acid and B12
- Vitamin C
- 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 oestrogen overload may occur, including greater risk of breast cancer.
A low level of B6 is associated with an excess of oestrogen in relation to progesterone 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[1a, 1b]. B6 alleviates depression associated with premenstrual syndrome. Also, premenopausal women in the top third for B6 levels cut their risk for breast
cancer by a third.
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 methylation, 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. Low magnesium levels are associated with poor appetite, nausea, lethargy, mood swings and muscle cramps. Magnesium reduces water retention and improves mood.
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).
Like vitamin B6 and zinc, magnesium is required for making prostaglandins, and may help PMS sufferers this way. Cramps are most commonly due to calcium/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. The decrease was the greatest in the Mg plus vitamin B6 group, and was the least in the placebo group.
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.
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. 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. Most studies gave 1,000mg of magnesium.
Getting enough magnesium also reduces cancer risk. A high magnesium intake almost doubles survival from breast cancer. 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.
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 serotonin levels and zinc has an anti-depressant effect. 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. A study in 2005 also found that ascorbic acid (vitamin C) infusion increased arterial compliance by 25% in postmenopausal women.
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 cortisol 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.
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. 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. The most recent study in 2017 found that women given 100mg of isoflavones had less hot flushes and imporvements in psychological symptoms. 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. In another randomised controlled trial, soya protein (high in isoflavones) versus milk protein as a placebo, reduced PMS scores and specifically headaches and breast tenderness.
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.
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.
Isoflavones also improve blood lipid profile glucose metabolism and associated inflammation and thus, metabolic syndrome[24,25], and prevent an increase in abdominal fat in post-menopausal women.
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.
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. 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[29a, 29b]. 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. 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.
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