Women's Health Report 2021

Understanding the tailored needs of women and identifying whitespace opportunities to support these needs through nutritional intervention.

Future of female nutrition

Understanding the tailored needs of women and identifying whitespace opportunities to support needs

Introduction

From nutrigenomics to nutritional therapy, more personalised approaches to diet and health in women are gaining ground. How do supplement brands respond to a growing consumer understanding that one size does not necessarily fit all? Paul Gander reports

Zita West, a midwife who founded a women’s dietary supplement brand under her own name over 15 years ago, has had a grandstand view of how female attitudes have evolved over that period.

“When I launched the range here in the UK, there were really only a select few women who understood the benefits of supplementation for fertility, especially; today, many more understand this,” she says.

“Pregnancy has always been a slightly easier ‘sell’, as the National Health Service (NHS) recommends women take folic acid, so many know to supplement.” She adds: “I think the postnatal period quite often gets forgotten about, and it’s as important as taking supplements during pregnancy, really.”

One challenge for this brand, and others which come with a premium price tag, is the importance of educating consumers about the benefits of bioavailability.

“Even if they know our supplements are ‘better’ than others, they’re also more expensive, and consumers don’t quite understand why,” West says. “We changed to folate from folic acid a few years ago—the body turns folic acid into folate to use it—and we still have a lot of women asking if they need to take a folic acid supplement, as ours don’t seem to contain it.”

Another ingredient which is a potential differentiator, but which can also cause confusion, is beta-carotene. This can be included as a way of avoiding the potentially harmful effects of excess vitamin A levels on pregnant women. “Vitamin A is still needed, but by using beta-carotene, the body will convert it to vitamin A on an as-needed basis,” says West. But some women see the mention of ‘beta-carotene’ and panic. “Certain brands would just leave vitamin A out altogether, if they were at the cheaper end of the market.”

Similar challenges are faced by brands serving other segments of the women's health market. Gut health, for example, can present issues related to messaging on probiotics.

Sophia Marinho de Lemos is a co-founder of the Källa brand (meaning ‘source’) of powdered supplements in Sweden. The range, which launches later this spring and will only be available online, is principally angled towards women, and is based around gut health and probiotics.

The enduring effects of the EU’s Nutrition and Health Claims Regulation (NHCR) mean that explicit claims about probiotics cannot be made. But the brand can identify the specific strains used. Of the For Relief variant targeting digestive health, she says: “We can also reference research, for example, the 50-plus clinical trials about the alleviation of irritable bowel syndrome (IBS) symptoms.”

Menopause and peri-menopause

Crucial need for nutrition and diet support

While gut health, pre-natal and fertility needs are vitally important areas of women’s health (and will be revisited), one theme which has seen an increasing focus over recent years is menopause. Here, demographics and the age distribution profile across the population has lent even more urgency to the search for options when it comes to nutritional support.

Society has evolved in other significant ways, according to Sophie Medlin, director of City Dietitians, London. “One of the first changes women may notice, with the onset of menopause, is a change in their cognitive function,” she says. “It may affect anxiety levels or short-term memory, but it can be quite worrying. It’s important to acknowledge that, only a few years ago, women of this age were generally less likely to be in responsible positions at work, less likely to still have younger children and elderly parents. The fact that today they may be juggling all of this means it becomes a challenging time to be going through these—and other—changes.”

Nutritional therapist Claire Foss underlines some broader shifts in attitude towards this period in a woman’s life. “For many women, menopause can be a very traumatic experience and have a huge impact on health, wellness and happiness,” she says.

Foss adds: “I still think there’s a slight disconnect when it comes to nutrition and menopause.” In other words, despite the greater all-round awareness, this does not necessarily feed through into an understanding of the implications for diet and nutrition. For many, the link between diet and weight loss, for example, is likely to be much clearer.

At the same time, Foss emphasises the way in which supplementation requirements can vary between individuals. “Some women present with obvious nutritional deficiencies and may require a multivitamin to boost levels,” she reports. “Other women have problems regulating their blood sugar, and chromium has been shown to be effective for this. Some women lack energy, and B vitamins can help to boost this, whereas others have aches, pains and trouble sleeping, and on these occasions magnesium may be beneficial.”

There is science to suggest it is beneficial to help support hormone balance, but even natural supplements do not come without risks.

Claire Foss, nutritional therapist

She is wary of fads for particular ingredients, plant-derived or not, which purport to offer the same benefits to all women. Maca is a case in point, says Foss: “There is science to suggest it is beneficial to help support hormone balance, but even natural supplements do not come without risks. If someone is sensitive to hormone-driven conditions, then maca would not be right for them.”

Ensuring women are consuming sufficient fish oils, B-vitamins and iodine becomes more important, Medlin says. “This is especially true as more women move away from eating animal products,” she adds. “There’s also this narrative that you should go veggie to get through menopause; but actually, if you’re not careful, you can develop deficiencies in certain areas.”

Medlin, who is also chair of the British Dietetic Association for London, points to sleep as another area “massively influenced” by menopause. Even with a mineral as apparently straightforward as magnesium, she says, it is not simply a matter of ticking an ingredient box. “Providing a good complex of magnesium is important,” she underlines, “and can help some women with sleep.”

“Peri-menopause is really poorly researched,” states Medlin. Individual women may see little continuity from month to month, and menstrual cycle patterns will differ from one woman to another. “That makes researching it difficult, too – and finding ingredients that work well for everyone.”

Menopause: a cultural comparison

Those eyeing Chinese nutritional supplement markets need to be aware of cultural and dietary differences, and none more so than in the area of the menopause.

At QIVA Global, an operations partner to international consumer health brands in China, managing director Ellie Adams is the first to agree that the attitudes of European women to menopause have, by and large, changed over the last few years. “A recent Swedish study found that 51% of women viewed menopause in a positive light, associating it with a strengthened sense of identity and self-awareness,” she reports.

Of course, many are still happy to take supplements if they will relieve the worst physical and mental impacts of the menopause. But in China, the emphasis falls very differently.

“There remains a deep-rooted belief in Chinese society that a woman’s purpose is child-bearing and fulfilling wifely duties,” Adams says. “So, the most popular menopausal products in China focus on prolonging fertility, in order to delay the onset of what is seen as a negative affliction.”

According to QIVA, some 75% of Chinese supplements for menopause aim to pre-emptively delay its onset. Soy isoflavones are the most common active plant-based ingredient, and the most important one in around 45% of supplements in this area. Others, such as deer placenta and powdered deer’s blood, would be less familiar to European consumers.

Despite significant Chinese media coverage of menopause, there is a stubborn negative stigma around the topic, with around 70% of Chinese thinking that their mother’s behaviour at this time in her life should be labelled ‘abnormal.’ “But, as the emerging middle class of highly-educated and wealthy Chinese continues to expand, more women are attempting to shun these labels,” says Adams.

Pre- and post-natal health

Nutrition for every stage of pregnancy

Back in the West—at Zita West, in fact—the brand’s founder underlines not only the greater preparedness among women to take supplements for fertility, but also their apparently greater willingness than men to understand this link – and act on it. “Amazingly, considering 50% of fertility issues are male-related, it’s still hard to get men to take fertility supplements,” she reports.

Apart from the shift—already mentioned—from folic acid to folate, the basic formulation for this supplement has otherwise stayed largely the same since the range first launched, West explains.

When it comes to pregnancy, it is arguable that the quality of food supplements is never more important than during this period. Medlin at City Dietitians reports that, surprisingly perhaps, the overall quality and—more specifically—the nutrient bioavailability of pre-natal products can still vary enormously. “In my opinion, there should be some sort of ‘traffic light’ system,” she argues.

One new and important trend is the tailoring of supplements for the different stages of pregnancy, typically in terms of the first, second and third trimester. “That means, for instance, you can provide more fish oils and omega-3 fats in general for the baby in the period when her brain is developing,” Medlin says.

West's brand includes targeted supplements for each trimester, as well as one for the post-natal period. “There are only small differences,” she admits. “But they’re important for each stage of the baby’s development in the womb. For example, Vital Essence 2 focuses on skeletal development with extra vitamin D, calcium and magnesium. Vital Essence 3 is all about building on energy for labour with more iron.”

In the post-natal period it’s extremely important for mothers to replace their iron stores, especially if there was a lot of blood-loss at the birth

Sophie Medlin, CityDieticians

In fact, this mineral features heavily either side of birth, as Medlin confirms. “In the post-natal period it’s extremely important for mothers to replace their iron stores, especially if there was a lot of blood-loss at the birth,” she explains.

She is happy to discuss the role of food supplements through every stage of a woman’s life journey without reference to the role of her own profession—until she reaches post-pregnancy. “If an expectant mother is trying to achieve a vegan pregnancy, she should seek advice from professional dietitians, otherwise, the calcium may be leached from her own bones, and the baby won’t have enough omega-3 to meet her needs.”

Across different health areas and ingredients, the current surge in interest in veganism has raised some interesting challenges for the supplements sector. West explains that her brand recently converted the majority of its products to being vegan-friendly. “All of them were vegetarian, apart from Vital DHA, which is fish oil,” she says. “It was finding the right capsule that was difficult, but we have a plant-based one now, rather than anything using lanolin. Although this isn’t an ‘animal product’, as it’s extracted from sheep’s wool, many vegans prefer not to use it.”

Currently, she adds, the brand cannot change its Vitamin D Spray to vegan-friendly, because that uses lanolin, too.

Meanwhile, Medlin is not alone in her concern about post-natal omega-3 levels. The science around omega-3 fatty acids may not be new, but their relevance to pregnancy and the post-natal period has become increasingly better-understood by women, according to West. It should come as no surprise that the brand’s Vital DHA is its top-selling product.

“DHA is less well-known for fertility, but in fact is just as important for egg health,” she says. “It’s always been a key nutrient for me—as key as folate.”

In terms of post-natal supplementation, the mix of nutrients is fairly well-established, says West, and innovation in her brand has come mostly in the areas of vegan-suitability and improved bio-availability, in particular for vitamin B6, calcium, magnesium and chromium. “We’ve added choline, too—an essential nutrient necessary for the development of healthy cell membranes, as well as a broader and more effective range of valuable antioxidants to help support the immune system,” she says.

Later in life, bone support becomes more important, and there is no lack of good-quality supplements available in this area, says Medlin. The temptation to ditch dairy at this more mature age should be treated with caution, even if the same nominal amount of calcium is provided by plant-based alternatives. “It’s not necessarily bioavailable,” she explains. “It’s to do with the complex of nutrients in dairy, including vitamin K and magnesium.”

From PCOS to endometriosis

Untapped and lacking science; booming with opportunity

Another health area receiving more attention, and where more supplement options are available, is polycystic ovary syndrome (PCOS). Estimates vary as to how many women suffer from this condition, but in the UK, for instance, it is thought to be at least 10% and possibly as much as 20% of the female population. Medlin points to the provision of inofolic supplements as a major step forward in this area, combining myo-inositol with folic acid.

“If a young woman is on the pill, it may well mask the symptoms,” she explains. “But supplements can help women to ovulate in a more regular way, and can minimise the growth of facial hair, acne and so on.” West emphasises the importance of inositol in cell-to-cell communication, but strikes a note of caution. “There is some evidence that suggests that supplementing with myo-inositol may help with irregular periods and ovulation in some cases,” she says.

There is some evidence that suggests that supplementing with myo-inositol may help with irregular periods and ovulation

Zita West, brand owner

But she points out that, as with many active ingredients, research to date is not particularly robust in terms of sample size, randomised controls, and so on. “So, the decision to try it has, in the end, to be one of personal judgement.”

Foss stresses the importance of seeking to uncover what may have triggered a certain disease or condition, and the degree to which this can vary from one woman to another. “I had great success with one client who suffered with endometriosis,” she recalls. “We introduced a probiotic to help support gut and digestive health, we removed dairy—which can be inflammatory for some—and she followed an anti-inflammatory diet. Just these small changes had an impact on her overall health.”

Probiotics, prebiotics and synbiotics

Boosting women's appeal

While gut health is not an area of exclusive concern to women, it can be argued that, along with probiotics in gut-related and other functional benefits, this is an area to which that they attach particular importance. Brand-owners and start-ups certainly see the strong potential of its appeal to women.

Like Marinho de Lemos, Aline de Santa Izabel is a Brazilian-heritage entrepreneur also, coincidentally, based in Stockholm, Sweden. Together, they exemplify some of the new attitudes and priorities around digestive health and probiotics.

While the former is about to launch her Källa range variants For Relief (digestive health), For Immune Health (immune health) and For Repair (targeting “chronic, low-level stress on the gut”), de Santa Izabel is working to establish her own synbiotics and gut-health business called Yogut. This aims to set consumers up with functional ingredients, including bacteria, and kitchen equipment for making their own fermented foods.

Although her starter range addresses conditions and concerns which are not gender-specific, Marinho de Lemos is from the outset targeting women as the brand’s core audience—and, typically, as the ‘supplement gatekeepers’ for the wider family. “Moving forward, though, our ambition is to strengthen the appeal of our range—and take it closer—to the women’s market. We’ll cement our position in relation to areas such as menopause.”

For her part, de Santa Izabel identifies some other types of benefit this might involve. “I think increasing numbers of women understand that the benefits of probiotics go beyond gut health, and include, for example, vaginal and urinary health,” she says.

New and emerging relations with regard to probiotics, many of them still not fully understood, include the gut-brain axis, Marinho de Lemos points out. Once again, of course, any benefits would not be specific to women.

The hurdles that the EU’s NHCR erected to claims under the banner of ‘probiotics’, among others, were heavily criticised by industry in the early days of the legislation. But with the passage of time, it may well have proved a boon to a new generation of brand-owners seeking to add value to supplements utilising specific bacteria and often communicating with more knowledgeable consumers.

As de Santa Izabel puts it: “More consumers are becoming increasingly savvy about the count of a particular bacteria and the strain.”

She adds: “It’s important to have regulation in place to prevent false claims and to ensure that products are grounded in science.” Only a few years ago, such words would have been more likely to originate inside the walls of the European Food Safety Authority (EFSA) than a nutrition industry start-up.

Potential challenges, potential solutions

Health through food, meaningful dosage, and nutrigenomics

Throughout her discussions around dietary supplements, Foss takes as her touchstone the functional medicine model. As she puts it: “We work from a personalised or ‘bespoke’ perspective. Although clients may have similar symptoms, the triggers for them may be different.”

This is just one of many current approaches to women’s nutrition, health and wellbeing which is emphasising the personal dimension.

Another is the science of nutrigenomics, which looks at the relationship between diet, health and genetics—which is, after all, the dimension which is most specific to any individual (see box-out).

Feasibly, this domain of personalised nutrition will continue to function as its own micro-climate, not affecting the broader market. Alternatively, it can be viewed as a longer-term threat—or a potential opportunity, if supplement formulators can find ways of working within this more personalised universe.

In the medium-term, brands are likely to find other ways of building a stronger rapport with women, and with consumers in general. Vegan-friendly formulation, as Zita West has demonstrated, is one such strategy. At Källa, Marinho de Lemos details others. “When we look at the gut-health market, there are very few brands marrying scientifically-based bacteria with a natural—and vegan—positioning.”

The greatest potential for women's health product development is in:

Female-specific chronic illness
Menopause support
Pre- and post-natal nutrition

If the brand’s designers have applied themselves to creating attractive packaging, this is not out of some fuzzy attempt to appeal to women. “A lot of people stop taking supplements because they forget,” she says, adding that this is often because the pack is kept out of sight. “Our packaging is designed to be kept in-view.”

Community-building, it could be argued, particularly with all the tools of social media now available, can also go a long way towards compensating for a lack of personalisation in the product itself. “Many customers just want the basics, such as information about when they should mix their probiotic and where they should store it,” says Marinho de Lemos. “Others will want more of a deep-dive into gut-health with input from experts.”

A further challenge to the traditional supplements market could increasingly come from consumers choosing to create their own foods and drinks at home with tailored nutrition. This could include fermented products such as kombucha, kefir and yogurt, says de Santa Izabel. “There is a growing understanding that each person has a unique gut with its own specific needs,” she says. “They want to understand what is the best option for them.”

Were her business to take off in a big way, it could see households buying not only less packaged yogurt but also fewer probiotic and synbiotic supplements. One benefit of this approach is that it would bypass the challenge of packing meaningful amounts of prebiotic into synbiotic capsules. But many will continue to be swayed by the convenience factor—they may want their supplementary nutrition to be even less bulky than it already is.

Achieving a meaningful dose of any ingredient within a small capsule or tablet can be a challenge. But by the same token, consumers may be reluctant to take three or four doses a day. The Zita West range typically advises a dosage of three capsules daily. “This is quite a lot for some people to take,” West admits. “We’ve managed to reduce it down with Vitafem to two capsules a day, and are currently trying to do the same with the Vital Essence [post-pregnancy] range.”

According to the company, certain antioxidants were substituted for others, and the greater bio-availability of some ingredients meant that a smaller volume was required.

New perspectives in nutrigenomics

There are few fields that can be traced back to a defined start-point, rather than emerging in a gradual evolution, but nutrigenomics is one of them. The publication of a draft sequence and analysis of the human genome almost exactly 20 years ago was followed by a final version two years later, providing researchers with the tools to integrate this into personalised nutritional insights.

Valentini Konstantinidou is a nutrigenetics and nutrigenomics coach and founder of DNANutriCoach. She was born in Greece but runs her business from Spain.

Konstantinidou completed her PhD research on genetic changes as a result of the Mediterranean diet, and particularly extra-virgin olive oil consumption in humans. “We began by investigating the changes in human gene expression after one month, a year, and so on,” she says. “Levels of the HDL and LDL fatty acids can be measured in the blood circulation, but what are the genes that drive any resulting change?”

The next step is to confirm if the up-regulation of those genes has a positive impact. Damaging or disease-related genes can also be down-regulated, she says.

This in turn led her and her colleagues into the field of nutrigenetics, which hinges on the differences between individuals on the basis of their DNA sequence. “It looks at the ways in which our bodies each process and digest the various nutrients differently, and at our personal sensitivity to dietary metabolisms,” Konstantinidou explains.

“What this brings is the ability to create tailor-made, personalised nutrition,” she says. “Whether during puberty, pregnancy or menopause, women have different nutritional needs. If we can target that nutrition as precisely as possible, we may be able to achieve long-term health and wellness.”

What a response to a particular DNA fingerprint might look like in terms of supplementation is a relatively new science requiring plenty of research—and plenty of care, says Konstantinidou. There is no shortage of university spinoffs and start-ups assessing, not only their offering, in terms of pinpoint nutrition, but also the price tag appropriate for such a tailored service.

In many cases, DNA analysis can highlight a simple solution, she says: “It may be to do with turning on or off a single element in a woman’s diet, and this can be transformative.”

Industry Experts - Q&A

Biographies

Our expert contributors

Ellie Adams, founder, QIVA Global

A fluent mandarin speaker, Ellie began her career at Thomson Reuters holding international postings across sales, marketing, and strategy functions. While Director of Government Affairs in Washington D.C., Ellie was recruited to join Monitor Deloitte. In 2017, Ellie founded QIVA Global to help international businesses build resilient brands in China. The QIVA model is built on data science, which powers everything the company does: from strategy, to brand building and sales.

Aline de Santa Izabel, founder, YOGUT ME

de Santa Izabel is a microbiologist, bioengineer, and food-tech entrepreneur with extensive experience in product development and innovation. As the founder of YOGUT ME, a science-based start-up pioneering personalised nutrition, she combined her passions for food innovation, microbiome science, and sustainability. She has also founded Synbiotic Kitchen, an educational platform that uses fermentation as a tool to promote knowledge about gut health and the microbiome.

Claire Foss, registered nutritional therapist, F O S S Nutrition

Foss studied nutritional therapy at the Institute for Optimum Nutrition and is a nutritionist and hormone expert. She helps women over 40 struggling through the effects of peri-menopause. Foss believes that the route to balanced hormones and good health is through evidence-based nutrition and lifestyle choices and this is reflected in her work.

Sophia Marinho de Lemos, co-founder, KÄLLA

Marinho de Lemos is the co-founder of KÄLLA, a Swedish probiotic brand redefining gut health for the modern woman. She has 10+ years of international experience in eCommerce, marketing, and digitalisation for FMCG companies. She authored an award-winning blog and currently mentors young women at one of Stockholm's premier business schools.

Sophie Medlin, dietician and founder, CityDieticians

Medlin is a well-recognised consultant dietitian in London with expertise in gastrointestinal and colorectal health. She worked in acute hospitals specialising in gastrointestinal diseases before moving into academia, where she worked as a lecturer at King’s College London. Medlin works as a consultant in product development for the manufacture of vitamins and probiotics.

Zita West, founder, Zita West Clinic

West has helped thousands of couples get pregnant each year both naturally and through IVF. Her speciality is a holistic approach that West uses as a practising midwife, acupuncturist and author of 13 books. She has her own range of vitamin supplements to support female and male fertility, as well as pregnancy and regularly appears in the press and on television.