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Фарманекс - Эстера
Документ описывает влияние женских половых гормонов, таких как эстроген и прогестерон, на здоровье и общее самочувствие женщин в разные жизненные периоды, включая пременопаузу и менопаузу. Также рассматриваются изменения в уровне гормонов, связанные с этими периодами, и их последствия, такие как остеопороз и сердечно-сосудистые заболевания. Приведены рекомендации по диете и дополнительным средствам, таким как Estera Maintenance, для снижения симптомов дисбаланса гормонов.
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Фарманекс - Эстера
- 1.
- 2. Уровень половых гормонов у женщиныпостоянно изменяется, влияя на ее самочувствие
- 3. Гормоны • Гормоны влияютна все процессы в организме – Репродуктивная функция – Работа сердца и циркуляция крови – Мыслительная и умственная активность – Плотность костной тани и тонус мышц – Молодость кожи – Жировая масса тела
- 4. • Женские половыегормоны –Эстроген –Прогестерон –Андрогены –Гонадотропины Половые гормоны
- 5. • Эстрогены – Стероидныегормоны, продуцируемые яичниками • Прогестерон – Стероидный гормон, продуцируемый желтым телом • Андрогены – Мужские половые гормоны. тестестерон • Гонадотропины – ФСГ и ЛГ Половые гормоны
- 6. • Метаболиты эстрогена Эстрогеныметаболизируются в печени Половые гормоны
- 7.
- 8. Пре- менструальный период Продуктивный период Пременопауза Мено пауз а Изменение уровняэстрогенов Стабильный Вариабельный Снижение Постмено пауза
- 9. Менопаузальный период (климактерический) Пременопауза МенопаузаПостменопауза 45....47.....48....49....50...51...52...53...55..60..65..70.. 1/3 всей жизни!
- 10. – Переходный периодмежду продуктивным и менопаузой Что происходит: снижение уровня эстрогенов – Самый ранний симптом – нерегулярный цикл – Средний возраст начала 47.5 лет – Может продолжаться от 2 до 10 лет Пременопауза North American Menopause Society. www.menopause.org
- 11. – Полное прекращениеменструального цикла на срок не менее 1 года – Средний возраст наступления менопаузы – 51 год Менопауза North American Menopause Society. www.menopause.org
- 12. • Что происходит? –В ответ на снижение ФСГ и ЛГ яичники прекращают свою функцию по поддержанию менструального цикла – Глубокое снижение синтеза эстрогена – Многие симптомы, наблюдаемые во время пременопаузы, сохраняются и в менопаузе Менопауза
- 13. – Период послеменопаузы – Яичники прекращают продукцию эстрогена, в то же время несколько повышается его синтез в жировой ткани – Продукция прогестерона снижается – Сохраняются симптомы менопаузы, наблюдаются поздние обменные нарушения Постменопауза
- 14. North American MenopauseSociety. www.menopause.org Симптомы менопаузального периода Ранние симптомы: приливы, чувствительность груди, ПМС, кровотечения, усталость, раздражительность, расстройство сна... Среднесрочные симптомы: сниженное половое влечение, вагинальная сухость, недержание, сухость и атрофия кожи Поздние симптомы: остеопороз, атеросклероз,остеоартриты, б- нь Альцгеймера Испытывая эти симптомы, 75% женщин отмечают нарушения привычного образа жизни, и хотят от них избавиться
- 15. Наибольшее беспокойство вызывают... National VitalStatistics Report, Vol 48, No. 11, July 24, 2000
- 16. Норма Истончение Угрозаперелома С момента менопаузы до 80 лет масса костной ткани снижается на 1/3 Остеопороз
- 17. Климактерий – 1/3жизни женщины! • Диета • Спорт • Снижение стрессов • Регулярно посещать врача с целью профилактики и раннего выявления заболеваний • Модификация диеты – Фитоэстрогены – И-3-К, лигнаны
- 18. Новый продукт,разработанный женщинами специально для женщин,которые находятся в периоде климактерия Улучшает женское здоровье и качество жизни. ESTERA Maintenance
- 19. ESTERA Maintenance 1. Помогаетуменьшить симптомы дефицита эстрогенов 2. Регулирует метаболизм эстрогена
- 20. Патентованная композиция ингредиентов Изофлавоны сои Экстрактграната Экстракт броколли Лигнаны льняного семени Фитоэстрогены нормализуют процессы, регулируемые эстрогеном Энзимные стимуляторы, помогающие управлять метаболизмом эстрогенов
- 21. Фитоэстрогены Растительные вещества, которыеобладают гормоноподобным действием в организме: 1. Связываются с рецепторами к эстрогену 2. Могут оказывать мягкий эстрогеноподобный эффект (1/1,000)
- 22. Эстера Майнтенанс содержит фитоэстрогеныиз 2 растительных источников: 1. Изофлавоны сои 2. Гранат Фитоэстрогены Soy isoflavones
- 23. Изофлавоны сои 1. Наиболееактивные растительные фитоэстрогены 2. Не все соевые продукты содержат изофлавоны
- 24. Все ли соевыепродукты одинаково полезны? Пищевые продукты с содержанием сои, пищевые добавки с соей: – Низкое содержание изофлавонов – Содержание изофлавонов варьируется Estera Maintenance – Содержит экстракт с высочайшим содержанием изофлавонов (64%) –Экстракт сои стандартизирован по генистеину (40%)
- 25. Изофлавоны сои Morabito. JBone Mineral Research. 2002 Повышают минерализацию костной ткани (длительное иссследование, 12 мес.)
- 26. Гранат • Используется вмедицине в течение нескольких сотен лет • Высокая антиоксидантная активность (ORAC) • Источник флавоноидов – 2.5% ellagic acid • Обладает фитоэстрогенной активностью
- 27. Метаболиты эстрогенов Все эстрогеныутилизируются в печени с образованием нескольких метаболитов.
- 28.
- 29. Метаболиты эстрогена • Некоторыеметаболиты, например 2- гидроксиэстрон, нейтральны • Другие, например 16-альфагидроксиэстрон, сохраняют активность и потенциально опасны (могут вызывать развитие опухолей)
- 30. Метаболиты эстрогенов • Курение,избыточная масса тела, диета с высоким содержанием жиров, малоподвижный образ жизни: (образуются 16-альфа метаболиты) • Диета с низким содержанием жиров, потребление овощей и фруктов, физическая активность приводят к улучшению метаболизма эстрогенов (образование 2-гидроксиэстрона)
- 31. Заблаговременное управление балансом метаболитовэстрогена - профилактика самых грозных заболеваний в более зрелые годы Метаболиты эстрогена
- 32. Энзимные регуляторы • Работаютв печени, удаляя нежелательные метаболиты • Сдвигают метаболизм эстрогенов в сторону 2-гидрокси
- 33. Энзимные регуляторы 1. Экстрактброколли 2. Лигнаны льняного семени – 20% стандартизация
- 34. Лигнаны льняного семени Наблюдательныеисследования продемонстрировали зависимость потребления пищи, содержащей лигнаны, со снижением заболеваний: -Молочных желез -Прямой кишки -Простаты -Сердца Adlercreutz 1997,Demark 2001
- 35. • Исследования показали, чтопотребление 6 и более порций броколли или цветной капусты оказывает благоприятное воздействие на баланс метраболитов эстрогена Дневное потребление
- 36. Метаболиты эстрогена Экскреция метаболитовэстрогена до и после начала приема экстракта броколли (95% CI). Michnovicz 1997
- 37. ESTERA Maintenance Formula •Помогает компенсировать симптомы дисбаланса гормонов • Подждерживает все процессы, связанные с балансом гормонов во время перименопаузы • Защищает оргнизм от «плохих» метаболитов эстрогена
- 38. Долговременная защита женщины •Сердце и сосуды • Мышцы • Кожа • Костная ткань • Умственная активность • Баланс липидов крови
- 39. Способ применения • По1 капсуле 2 раза в день во время приема пищи. • Противопоказания: Беременность, кормление грудью, индивидуальная непереносимость компонентов.
- 40. Комплементарные продукты Perimenopause Nutritionals LifePak® / MarineOmega™ Solutions Estera™Maintenance Complementary Products ageLOC Vitality Managing Life Style Tēgreen 97
- 41.
Editor's Notes
- #2 We are excited to introduce a brand new women’s line of health supplements-Estera ™ . Products made by women, “ For Women, for Life. ”
- #3 When women’s health is discussed the first thing that probably comes to everyone’s mind is our erratically changing hormone levels. There’s no way around it, women are complicated, but it’s not our fault! The good news is there is help to manage these hormones better.
- #4 It may surprise you to learn that hormones affect almost every function in your body. How fast your heart beats, and how your blood flows. How sharp your thinking is, and how much you remember, to how strong your teeth and bones are, and how your muscles grow. Hormones affect how shiny your hair is, and smooth or wrinkled your skin is. How much fat you have, and where you store it. It even affects you overall libido, or overall life energy. In fact, it is hard to find a function of your body that is NOT affected by hormones!
- #5 Now, all humans have the same sex hormones: Estrogen, progestrone, androgens, and Gonadotropins. Women have more estrogen, while men have more androgens.
- #6 Estrogen is a family of steroid hormones that are produced primarily by the ovaries and are responsible for the development of female reproductive organs and secondary sex characteristics. There are three primary estrogen compounds in the body; estradiol, estriol and estrone, each of which plays a dominant role in a woman’s phase of life. Progesterone is the primary steroid hormone produced by the corpus luteum during the menstrual cycle. The corpus luteum is a yellow body produced in the ovaries during the menstrual cycle whose primary function is to secrete the hormone progesterone after ovulation. Progesterone is responsible for preparing the female body for pregnancy and is necessary to maintain pregnancy until birth. Androgens are also sex hormones and are more dominant in males. The major androgens in women and men are testosterone, androstenedione, dehydroepiandrosterone (DHEA) and the metabolite dihydrotestosterone. They are steroid hormones that control the development and maintenance of masculine characteristics. Testosterone is the primary sex hormone for men and is produced in the testes. Women, however, also produce testosterone in the ovaries and androstenedione (building block of testosterone) in the adrenal glands but to a much smaller degree. In women, serum testosterone is only 10% of that of males. Testosterone in women is primarily responsible for libido, but may also affect thyroid function, energy levels, mood, depression, muscle mass, strength, bone density and distribution of adipose tissue. Gonadotropins are hormones that stimulate the growth of the reproductive organs: ovaries in women and testes in men. FSH (follicle-stimulating hormone) and LH (Luteinizing hormone) are the two primary gonadotropins and are necessary to induce the production of estrogen from the ovaries and progesterone from the corpus luteum in women.
- #7 This brings us to another concern that affects women of all ages, but generally shows up in women who are in Phase II and especially Phase III. That is the issue of estrogen metabolites. All estrogen, whether it is produced by the body, or obtained from drugs or from exposure to environmental estrogen must be metabolized, or processed, by the liver. A metabolite is any product of metabolism, including waste products.
- #8 Some estrogen metabolites, like 2-hydroxyestrone , are beneficial While others, such as 16-alphahydroxyestrone, can be harmful
- #9 In the childbearing years the hormones estrogen and progesterone remain somewhat stable. It is prior to a woman’s menstrual cycle that estrogen and progesterone fluctuate slightly, but just enough to create a condition known as premenstrual syndrome or PMS.
- #11 Perimenopause is the transition period between your reproductive years and menopause. This is a time when the ovaries and other systems begin to wear out and become inconsistent in their performance. One of the earliest signs is irregular periods or heavy bleeding. This can start as early as the mid 30’s and can last up to ten years!
- #12 Menopause is the time when your periods have ceased for one complete year.. Menopause can occur naturally, artificially or prematurely. Natural menopause typically occurs between 40 and 58 years of age, with the average age being 51
- #13 The time leading up to true menopause, the ovaries response to FSH and LH decreases, This means less estrogen will be produced as well as progesterone and ultimately a woman’s normal monthly period will cease to occur. Because of the dramatic decrease in hormone production women who have reached menopause may continue to experience many of the same symptoms they did in perimenopause.
- #14 The time immediately after the diagnosis of menopause is termed postmenopause. During postmenopause estrogen is still present in the body. The ovaries have stopped producing estrogen, and instead adipose tissue or rather fat tissue takes over and ultimately produces a weaker form of estrogen called estrone from the conversion of DHEA. (DHEA is produced by the adrenal cortex and then converted by aromatase enzymes in visceral fat cells to androstenedione and ultimately to estrone). Progesterone also significantly declines and the symptoms experienced in perimenopause and menopause may continue with the addition of some new symptoms such as urinary incontinence, sexual discomfort and changes to the skin due to the lack of estrogen.
- #15 The earliest signs of perimenopause are irregular menstrual periods. Approximately 90% of women experience changes in their menstrual cycles 4 to 8 years before they reach menopause. A woman’s menstrual cycles in perimenopause will generally become shorter and bleeding can be lighter or heavier, and their cycle may even skip for several months before resuming. Other common symptoms are hot flashes, sleep disturbances, vaginal dryness, and mood swings. Hot Flashes are the most common discomfort noted by women in perimenopause. Hot flashes can also occur anytime of the day or night. At night heavy perspiration can occur causing what is called “night sweats”. Hot flashes are the symptom that causes most women to seek treatment during perimenopause. About 85% of women experience hot flashes to some degree. And will all symptoms, 75% of women during perimenopause experience enough discomfort to seek treatment. Interestingly, hot flashes and night sweats are more common on European and North American women.
- #16 It is interesting to note that if you ask women what their biggest health fear is, most women will say…breast health. But in reality, only 4 percent of women’s deaths are related to breast health, while 42 percent are related to heart health.
- #18 So, what can you do to help yourself in this phase? You can start by eating smaller and more frequent meals that include plenty of cruciferous vegetables. Exercise is so critical in this phase to keep yourself going! Weight bearing exercise will help keep your bones strong, while cardiovascular exercise will help your whole cardiovascular system healthy. With hormones changing drastically, and often with the accompaniment of other life changes, this is a time that can generate a lot of stress. Get plenty of sleep, which will be easier to do if you are exercising. And this may be a time to add some new relaxation techniques to your daily routine. It can be helpful to note the timing of things like hot flashes. Pay attention to see if there are any specific triggers that bring them on. For instance, I know someone that can trace the occurrence of a hot flash right after she eats sugar.
- #19 Estera is a line of nutritional and complementary healthcare products formulated to increase women’s health and quality of life during the major phases of life: the childbearing, perimenopause, and postmenopause years. Estera is “for women, for life.” Another unique aspect of Estera is that it has been formulated by women, for women, and will be distributed by a powerful women distributor force.
- #20 Estera ™ is different than other traditional dietary supplements for women on the market today. It is the first line of women ’ s health products that targets the different phases in a woman ’ s life and contains ingredients not only to help with each unique phase she will experience but to protect her health throughout her lifetime. Each of the products we will introduce today will focus on the key aspects of women ’ s health; balancing hormones, protecting against potentially harmful estrogen metabolites and focusing on the unique symptoms that occur in particular phases.
- #21 What makes Estera ™ stand out? Estera products contain a patent-pending blend of phytonutrients and enzyme inducers that will help to balance women ’ s changing hormone levels and protect against metabolites. We ’ ll discuss these in more depth.
- #22 Plant compounds comprise one part of the patent-pending blend in Estera ™ . These plant compounds have 2 beneficial properties to them. Firstly, these particular phytonutrients exhibit “ competitive inhibition ” . What does that mean? The chemical structure of phytoestrogens is similar enough to that of estrogen so that they can bind to the estrogen receptor on cells, yet different enough so that they only perform very weak estrogen effects (1/1,000 of estradiol). Estrogen receptors are proteins that are located on cells in various tissues; these receptors have specific shapes and when bound to specific compounds will exert very specific effects. These estrogenic-like effects are desirable for bones, and possibly for heart and brain, but in the postmenopause years, estrogenic effects on the uterus, endometrium, and breast appear to increase risk in those tissues. By plant compounds binding to these receptors before estrogen can, or in other words “compete” for cell receptors, you may be able to protect yourself from the effects of increased exposure to estrogen in your later years which is associated with higher risks of certain serious health conditions. Secondly, these plant compounds mimic estrogen effects in the body but to a smaller degree. Estrogen is one of the key sex hormones in a woman ’ s body. It virtually affects almost everything in a woman ’ s body, from the way she looks and feels to how healthy her bones and heart are. When our estrogen levels become unstable, our body can go through unpleasant changes. Supplementing with these particular types of plant compounds helps to maintain stable estrogen levels and offer health protection to our bodies.
- #23 The Estera ™ product line contains two sources of plant compounds; soy isoflavones and pomegranate.
- #24 Soy Isoflavones are a specific type of plant compound found in soy. Isoflavones comprise the most widely used plant compound for menopause. As mentioned, the particular isoflavones are found in soy, BUT it is important to realize that not all soy contains the particular isoflavone.
- #25 Not all soy is equal. Consuming food and/or supplements with soy is a great start to improving your health, however, most soy foods contain only a small percentage of isoflavones, some are extracts that contain varying levels of these plant compounds, or isoflavones. Isoflavones are found naturally in people’s diets in soy products. However, the level of isoflavones in soy products varies based on harvesting, manufacturing, and preparation methods. Soy products currently on the market are often not standardized, or are only standardized to 40% isoflavones or less. Furthermore, the levels of other beneficial nutrients can vary dramatically in these standardized isoflavone extracts What kind of soy are you taking? Let’s break it down.Typically a high soy isoflavone extract contains 40% isoflavones. Of that 40%, another major phytonutrient is 40% of that soy isoflavone extract.In other words, it is only 16% of the original soy extract! To provide a consistent intake of important phytonutrients and isoflavones in a daily diet, Pharmanex provides a proprietary standardized 40% phytonutrient, 64% isoflavone extract. This is the highest potency soy extract available on the market that still maintains a natural isoflavone ratio of important plant compounds.
- #26 Isoflavone treatment has been shown to reduce the rate of bone resorption and increase the rate of bone formation in epidemiological studies. One randomized, double-blind placebo-controlled study published in the Journal of Bone and Mineral Research in 2002 found that particular soy isoflavone supplementation (54 mg/day) was as effective as Hormone Replacement Therapy (HRT) in preventing menopause-related bone loss. After 12 months, the percent change in femoral neck Bone Mass Density (BMD) for placebo, soy isoflavones, and HRT was -0.65, 3.5, and 2.4, respectively. For the same time period, percent change in Ward’s triangle BMD for placebo, soy isoflavones, and HRT was -0.36, 4, and 3, respectively (p<0.01). Both isoflavones and HRT significantly increased bone mass density in the femoral neck and ward’s triangle (area of the femur).
- #27 Pomegranate is one of the oldest medicines and is said to have flourished in the Garden of Eden. FYI-. Pomegranates were known as the “fruit of the dead” in ancient Greek mythology, and pomegranate adorned the vestments of the high priest in ancient Hebrew tradition. For the ancient Chinese, pomegranate seeds symbolized longevity and immortality, while the Persians believed the seeds conferred invincibility on the battlefield, and the Babylonians regard the seeds as an agent of resurrection. Pomegranate is composed of a rich variety of antioxidant flavonoids, including the anthocyanins ellagic acid. Our pomegranate extract is standardized to 2.5% ellagic acid. Research indicates that ellagic acid is an inhibitor of free radical damage caused by foreign chemicals. The flavanoids in pomegranate are excellent antioxidants and can help fight free radicals. Emerging scientific evidence has identified pomegranate to have particular plant compounds, a structurally similar compound to estrone, a metabolic derivative of estradiol.
- #28 Many of you may not be as familiar with estrogen metabolites as you are with the term phytoestrogen. This however is a very important concept that until recently hasn’t been addressed when discussing women’s health products. Pharmanex is one of the first to address this issue in women’s health supplements. First, what is an estrogen metabolite. Estrogen like many other things is metabolized in the liver. The process of metabolism causes metabolites. A metabolite is any product of metabolism, including waste products. Thus when estrogen is metabolized, it simply produces a by product called estrogen metabolites.
- #29 Estrogen metabolites are created from the breakdown of estrogens naturally produced by the body, as well as the estrogen found in prescription medications, foods, and the environment. This is a diagrams of the chemical structure of estrogen metabolites.
- #30 The two main ways estrogen is metabolized in the liver produce two completely different metabolites . Some estrogen metabolites like 2 hydroxyestrone are neutral. However a potentially harmful metabolite called– 16-alphahydroxyestrones can also be produced. Estrogen is vital for many body functions, however, long term exposure to estrogen has been shown to be potentially harmful. These 16 alphahydroxyestrones remain active, thus increasing a woman’s exposure to estrogen throughout her lifetime.
- #31 Reseachers have found that women who smoke, are obese, have high fat diets and sedentary lifestyles have increased ratios of 16 alphahydroxyestrone metabolites to the neutral 2 hydroxyestrone metabolites. Likewise, those who consume a low fat diet with a high intake of fruit and vegetables and those who exercise have a a better ratio of 2 hydroxyestrone metabolites.
- #32 Women with a variety of cancers (cervical, colon, breast, lung and larynx) have a higher ratio of 16-alphahydroxyestrones, while those with an increased ratio of 2-hydroxyestrones have been shown to have a decreased occurrence of these diseases. These diseases often show up when women are in the postmenopause years. Efforts to metabolize estrogen in a healthy way in earlier years may reduce the level of lifetime estrogen exposure, but for those who have not taken these steps earlier need to increase their preventative measures.
- #33 Enzyme inducers help to promote the 2-hydroxyestrone/16-alphahydroxyestrone liver enzyme ratio in favor of the 2-hydroxy enzyme system. This causes the liver to convert estrogen into 2-hydroxy metabolites instead of the more harmful 16-alpha metabolites. Consumption of enzyme inducers helps to decrease the risks associated with the harmful estrogen metabolites, by shifting the metabolism toward the neutral metabolites, as well as decreasing the estrogen activity of these metabolites.
- #34 The Estera line contains 2 different enzyme inducers, certain types of Broccoli extract are produced by the body from naturally occurring glucosinolates in a wide variety of foods, especially cruciferous vegetables (Brassica family), such as broccoli, cabbage, bok choy, cauliflower, and brussels sprouts. Flaxseed consists of the dried, ripe seed of the Linum usitatissimum L . Lignans are a major component of the fiber portion of flaxseed that have only recently been made available in the market as a standardized extract. Flaxseed lignans act as enzyme inducers to promote favorable metabolism of estrogen metabolites by reducing the 16-alpha/2-hydroxy estrogen metabolite ratio. . Studies have shown that dietary and supplemental flaxseed lignans increase urinary 2-hydroxyestrone, but not 16-hydroxyestrone. Estera is standardized to contain 20% lignans.
- #35 Observational studies suggest that people who eat more lignan-containing foods have a lower incidence of breast and perhaps colon cancer. Some preliminary research indicates that flaxseed lignans may also fight cancer in other ways, perhaps by acting as antioxidants. Pre-clinical and preliminary human studies suggest that flaxseed and its lignans may also reduce risk of cardiovascular disease by reducing total and LDL cholesterol, and reducing LDL oxidation, more research needs to be conducted.
- #36 We all know that eating a diet high in fruits and vegetables is important. Studies indicate that consuming 6 or more servings of cruciferous vegetables provides health benefits. When was the last time you consumed 6 or more servings?
- #37 Broccoli extract induces enzyme activity in the liver, shifting the metabolism ratio of estrogens towards an increase in 2-hydroxy metabolites and a decrease in 16-alpha metabolites. Results of a study published in the Journal of Nutrition in 1997 found that after only one week, the urinary concentration of 2-hydroxyestrone increased by an average of 91% whereas that of urinary 16-alpha-hydroxyestrone levels decreased by 45%.
- #38 Postmenopausal women are faced with three primary areas of concern: (1) understanding the long-term health impact of normal hormone fluctuations, (2) incorporating diet and lifestyle choices to help the liver eliminate undesirable metabolites, and (3) addressing common symptoms associated with the postmenopausal years While the symptoms that most women experience in perimenopause leading up to menopause present some of the more uncomfortable symptoms, the health effects due to the lack of estrogen in postmenopause present some of the most serious health conditions such as cardiovascular disease and osteoporosis.
- #39 Estera Phase III is formulated with higher amounts of phytoestrogens to support cardiovascular health, muscle, skin tissue, healthy bones, and cognitive function, and helps maintain healthy lipid profiles in postmenopausal women.
- #40 Estera Phase III is formulated with higher amounts of phytoestrogens to support cardiovascular health, muscle, skin tissue, healthy bones, and cognitive function, and helps maintain healthy lipid profiles in postmenopausal women.
- #41 Like all Pharmanex products, Estera is formulated to be taken with other Pharmanex products to help support healthy lifestyles. Here is a graph to help you determine which products will work best for you. Our LifePak products in combination with Marine Omega provide the foundation for a healthy lifestyle. For those who are looking to help reduce excess weight, perhaps due to menopause, the TRA line is a perfect addition to your dietary supplement regimen.