Change of life for herb makers?

Timing could not be better for nutritional supplement manufacturers, including two local San Fernando Valley companies that have recently introduced products to relieve menopause symptoms.

A just released clinical study revealed that hormone replacement therapy, a pharmaceutical treatment for menopause, carries heightened risks for heart disease, breast cancer, blood clots and strokes. The widely publicized survey results have alarmed and confused patients, and a number of doctors have already moved to stop HRT treatment.

The news about HRT brings front and center nutritional supplement makers such as Natrol Inc. and Pharmavite LLC and could provide a much needed shot in the arm for an industry that has been alternately ignored by the medical community and beset by negative news reports.

"For a long time, a lot of these companies that produced supplements for menopause-related issues have been trying to get the word out, but they've been fighting for the ear of the consumer against well-funded pharmaceutical companies," said Patrick Rea, research director at Nutrition Business Journal in San Diego. "There's probably companies right now reorienting products and marketing messages all the way down to store promotional materials to capture these consumers looking for alternative solutions."

Indeed, the Dietary Supplement Education Alliance, an industry trade group, has already moved to produce a video to help educate consumers to herbal supplements as an alternative to HRT.

In Chatsworth, Natrol officials are looking at beefing up consumer education materials and launching a radio campaign to heighten awareness of the company's menopause products.

And at Pharmavite in Northridge, there's a budding awareness that the latest events could provide needed support to extend product development efforts.

"We have not yet had a deluge of sales guys coming to us," said John Metz, senior product manager for Nature's Resource, Pharmavite's herbal supplement division. "But yesterday one of our major sales guys came to me and said we really ought to be taking advantage of this. So we could conceivably look into expanding our menopausal products."

Each year about 1.8 million women in the U.S. reach menopause. Among the symptoms they may experience are hot flashes, night sweats and bone loss. Individual symptoms vary as does intensity, but about 70 percent to 80 percent of menopausal women experience hot flashes and night sweats to some degree.

HRT, a combination of estrogen and progestin, most widely distributed under the brand name Prempro from pharmaceutical maker Wyeth, has been used to alleviate these symptoms and to decrease the risk of heart disease, which rises for women who have reached menopause.

About 6 million women in the U.S. take HRT, according to the National Institutes for Health.

But immediately after the clinical study results were announced, a survey conducted by ImpactRx, which tracks pharmaceutical companies' promotional efforts, found that physicians told nearly half of their patients to stop taking Prempro or to switch to another therapy.

Meanwhile, herbal supplement makers have been slowly building a $250 million market in products ranging from black cohosh to red clover and soy isoflavones along with specially formulated combinations of these herbs, which have been shown to relieve many symptoms of menopause to varying degrees. According to Nutrition Business Journal, herbal supplements used to relieve symptoms of menopause grew by 6 percent in 2001 versus the prior year, compared to a 4-percent growth rate for the overall herbal supplement market.

Pharmaceutical makers have been the largest players in the market. GlaxoSmithKline markets Remifemin, a product based on black cohosh, which has been widely used in Germany. Novogen, an Australian pharmaceutical company, markets Promensil, a combination of soy isoflavones and red, clover.

So-called nutraceutical companies have long marketed herbs like black cohosh, but recently began to formulate combinations of these herbs targeted specifically to menopausal symptoms.

Last year, Natrol introduced Complete Balance Am/PM Menopause Formula and earlier this year, Pharmavite launched Soy Balance Menopause Soy Supplement in its Nature's Resource line.

But despite the apparent opportunities now available, these companies are stopping short of launching an all-out marketing assault.

For one thing, they can't afford it.

"The dietary supplement industry does not have the resources to put 50,000 salespeople out there calling on each doctor's office," said Elliott Balbert, founder and CEO of Natrol.

Then too, the industry is fighting a long history of criticism and skepticism in the press and from the medical community and confusion over dosage and potency levels. Most feel they must tread softly and carefully to overcome some of these preconceptions.

Finally, physicians are not likely to provide much support, even in light of the recent news about HRT.

"Most doctors are still without the knowledge to comfortably discuss herbal remedies with their patients," said Dr. Michael Hirt, founder and director of the Center for Integrative Medicine at Encino-Tarzana Regional Medical Center. "That's important. If he or she does not know the ins and outs of that therapy, how to manage somebody, the right dosage, those are things that are taught in medical school in dealing with prescription medications. There isn't that kind of focus (for herbal supplements). So I think a lot of patients are going to be looking for alternatives, and doctors are no more comfortable today than they were three hours before the study was released to help women make the decision."

What the nutraceutical companies can do is step up their educational efforts, and many are doing just that.

Officials at Pharmavite, which expects its new menopause supplement to reach $3 million in retail sales annually, have focused their educational efforts on pharmacists and consumers. The company holds continuing education courses for health practitioners and nutritionists and it has revamped its packaging to offer more information in layman's terms.

Natrol is preparing a media kit to provide information about its menopause supplements and the company is working on a white paper to address a variety of topics from legal issues to efficacy and safety. When it's completed, Balbert said it will be included on the company's Web site.

That's something we weren't considering a month ago," he said.