Effect of soy protein foods on low-density lipoprotein oxidation and ex vivo sex hormone receptor activity--a controlled crossover trial

Polyphenols and atherosclerosis: A critical review of clinical effects on LDL oxidation

Atherosclerosis is a major etiology of cardiovascular disease that causes considerable mortality. Oxidized low-density lipoprotein (oxLDL) is a fundamental attributor to atherosclerosis. Therefore, there seems to be an essential place for antioxidant therapy besides the current treatment protocols for coronary heart disease. Polyphenols are a class of compounds with substantial antioxidant properties that have shown the ability to reduce LDL oxidation in preclinical studies. However, clinical evidence has not been as conclusive although offering many promising signs. This review aims to examine the trials that have evaluated how dietary intake of polyphenols in different forms might influence the oxidation of LDL. Lowering the circulating cholesterol, incorporation into LDL particles, and enhancing systemic antioxidant activity are among the main mechanisms of action for polyphenols for lowering oxLDL. On the other hand, the population under study significantly affects the impact on oxLDL, as the type of the supplement and phenolic content. To conclude, although the polyphenols might decrease inflammation and enhance endothelial function via lowering oxLDL, there are still many gaps in our knowledge that need to be filled with further high-quality studies.

The Antioxidant Role of Soy and Soy Foods in Human Health

Oxidative stress seems to play a role in many chronic diseases, such as cardiovascular diseases, diabetes, and some cancers. Research is always looking for effective approaches in the prevention and treatment of these pathologies with safe strategies. Given the central role of nutrition, the identification of beneficial healthy foods can be the best key to having a safe and at the same time effective approach. Soy has always aroused great scientific interest but often this attention is galvanized by the interaction with estrogen receptors and related consequences on health. However, soy, soy foods, and soy bioactive substances seem to have antioxidant properties, suggesting their role in quenching reactive oxygen species, although it was frequently mentioned but not studied in depth. The purpose of this review is to summarize the scientific evidence of the antioxidant properties of soy by identifying the human clinical trials available in the literature. A total of 58 manuscripts were individuated through the literature search for the final synthesis. Soy bioactive substances involved in redox processes appear to be multiple and their use seems promising. Other larger clinical trials with adequate standardization and adequate choice of biomarkers will fill the gap currently existing on the suggestive role of soy in antioxidant mechanisms.

Effects of an 8-Week Protein Supplementation Regimen with Hyperimmunized Cow Milk on Exercise-Induced Organ Damage and Inflammation in Male Runners: A Randomized, Placebo Controlled, Cross-Over Study

Prolonged strenuous exercise may induce inflammation, cause changes in gastrointestinal permeability, and lead to other unfavorable biological changes and diseases. Nutritional approaches have been used to prevent exercise-induced inflammatory responses and gastrointestinal disorders. Hyperimmunized milk, obtained by immunizing cows against specific antigens, promotes the development of immunity against pathogens, promotes anti-inflammatory effects, and protects intestinal function. Immune protein (IMP) is a concentrated product of hyperimmunized milk and is a more promising means of supplementation to protect against acute infections and inflammation. To determine whether IMP has protective properties against exercise-induced gastrointestinal dysfunction and inflammation, we examined biochemical markers, intestinal damage markers, and pro-/anti-inflammatory profiles of young male runners using a randomized, placebo controlled, cross-over design. Urine samples were collected and used for measurements of creatinine, N-acetyl-β-d-glucosaminidase, osmotic pressure, and specific gravity. Titin was measured as a muscle damage marker. Further, urine concentrations of complement 5a, calprotectin, fractalkine, myeloperoxidase, macrophage colony-stimulating factor, monocyte chemotactic protein-1, intestinal fatty acid binding protein (I-FABP), interferon (IFN)-γ, interleukin (IL)-1β, IL-1 receptor antagonist, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p40, and tumor necrosis factor (TNF)-α were measured by enzyme-linked immunosorbent assays. We demonstrated that urine osmotic pressure, urine specific gravity, I-FABP, IFN-γ, IL-1β, and TNF-α were reduced by 8 weeks of IMP supplementation, indicating that IMP may have potential in preventing strenuous exercise-induced renal dysfunction, increased intestinal permeability, and inflammation. Thus, IMP supplementation may be a feasible nutritional approach for the prevention of unfavorable exercise-induced symptoms.

Effect of a balanced Korean diet on metabolic risk factors among overweight/obese Korean adults: a randomized controlled trial

PURPOSE

This study was to see the effects of a balanced Korean diet (BKD) on metabolic risk factors in overweight or obese Korean adults, comparing with those of a typical American diet (TAD) and a diet recommended by the 2010 Dietary Guidelines for Americans (2010DGA).

METHODS

The study was designed as a randomized crossover controlled trial, in which 61 overweight or obese volunteers were divided into six groups and each consumed the BKD, 2010DGA, and TAD in a random order for 4 weeks separated by 2-week washout intervals. Anthropometric indices, blood pressure, blood lipid content, fasting blood glucose, and blood insulin level were measured at the beginning and end of each diet period.

RESULTS

A total of 54 participants completed the trial. The BKD caused more significant reductions of body mass index (BMI) (p < 0.001), body fat percent (p < 0.001), blood total cholesterol (p < 0.001), and low-density lipoprotein (LDL) cholesterol (p = 0.007) compared with the 2010DGA or TAD (all p values for differences between diets < 0.05). All three diets significantly lowered blood triglyceride levels (p < 0.05). The BKD decreased high-density lipoprotein (HDL) cholesterol (p = 0.001) and increased fasting blood glucose (p = 0.018), whereas TAD and 2010DGA increased HDL cholesterol and did not affect blood glucose levels. Furthermore, the BKD significantly decreased the proportion of individuals with elevated total cholesterol (p < 0.001) and LDL cholesterol (p < 0.01), whereas the 2010DGA significantly reduced the number of obese individuals (p < 0.05), and the TAD decreased the number of participants with elevated triglyceride levels (p < 0.05), but increased that of those with elevated LDL cholesterol (p < 0.05).

CONCLUSIONS

The Korean diet based on dietary guidelines improved metabolic risk factors such as BMI, body fat percent, and blood lipid profiles in overweight or obese Korean adults. These results provide evidence to recommend the Korean diet for preventing various metabolic diseases.

CLINICAL TRIAL REGISTRATION

The trial was registered at the Clinical Research Information Service (CRIS) in Korea, the primary registry of the World Health Organization (WHO) international clinical trial registry platform, under number KCT0002437.

The history and basic science development of soy isoflavones

This review summarizes the 2016 NAMS/Pfizer-Wulf H. Utian Endowed Lecture that focused on the history and basic science of soy isoflavones. Described is a personal perspective of the background and history that led to the current interest in soy and isoflavones with a specific focus on the role that soy isoflavones play in the health of postmenopausal women. This overview covers the metabolism and physiological behavior of isoflavones, their biological properties that are of potential relevance to aging, issues related to the safety of soy isoflavones, and the role of the important intestinally derived metabolite S-(-)equol.

Polyphenols from Root, Tubercles and Grains Cropped in Brazil: Chemical and Nutritional Characterization and Their Effects on Human Health and Diseases

Throughout evolution, plants have developed the ability to produce secondary phenolic metabolites, which are important for their interactions with the environment, reproductive strategies and defense mechanisms. These (poly)phenolic compounds are a heterogeneous group of natural antioxidants found in vegetables, cereals and leguminous that exert beneficial and protective actions on human health, playing roles such as enzymatic reaction inhibitors and cofactors, toxic chemicals scavengers and biochemical reaction substrates, increasing the absorption of essential nutrients and selectively inhibiting deleterious intestinal bacteria. Polyphenols present in some commodity grains, such as soy and cocoa beans, as well as in other vegetables considered security foods for developing countries, including cassava, taro and beetroot, all of them cropped in Brazil, have been identified and quantified in order to point out their bioavailability and the adequate dietary intake to promote health. The effects of the flavonoid and non-flavonoid compounds present in these vegetables, their metabolism and their effects on preventing chronic and degenerative disorders like cancers, diabetes, osteoporosis, cardiovascular and neurological diseases are herein discussed based on recent epidemiological studies.

Role of phytoestrogens in prevention and management of type 2 diabetes

Type 2 diabetes (T2D) has become a major public health threat across the globe. It has been widely acknowledged that diet plays an important role in the development and management of T2D. Phytoestrogens are polyphenols that are structurally similar to endogenous estrogen and have weak estrogenic properties. Emerging evidence from pre-clinical models has suggested that phytoestrogens may have anti-diabetic function via both estrogen-dependent and estrogen-independent pathways. In the current review, we have summarized the evidence linking two major types of phytoestrogens, isoflavones and lignans, and T2D from epidemiological studies and clinical trials. The cross-sectional and prospective cohort studies have reported inconsistent results, which may due to the large variations in different populations and measurement errors in dietary intakes. Long-term intervention studies

using isoflavone supplements have reported potential beneficial effects on glycemic parameters in postmenopausal women, while results from short-term small-size clinical trials are conflicting. Taken together, the current evidence from different study designs is complex and inconsistent. Although the widespread use of phytoestrogens could not be recommended yet, habitual consumption of phytoestrogens, particularly their intact food sources like soy and whole flaxseed, could be considered as a component of overall healthy dietary pattern for prevention and management of T2D.

Cardiovascular friendly natural products: a promising approach in the management of CVD

Natural products play an important role as nutritional supplements and provide potential health benefits in cardiovascular diseases (CVD). Compiling data from experimental, epidemiological and clinical studies indicates that dietary nutrients have profound cardioprotective effects in the primary as well as secondary prevention of coronary heart disease, hence they are considered as cardiovascular friendly natural products. The mechanism of cardioprotection produced by dietary nutritional supplements such as flavonoids (citrus fruits, pulses, red wine, tea and cocoa), olive oil, omega-3 (omega-3) fatty acids (fish oil and fish-based products), lycopene (tomato and tomato-based products), resveratrol (grapes and red wine), coffee, and soy in the prevention and treatment of cardiovascular disorders have been discussed in the present review, with the emphasis of epidemiological and clinical studies. Based on the intriguing results of various studies, prophylactic and therapeutic potential of cardiovascular friendly natural products have been suggested. The supplementation of cardiovascular friendly natural products needs to be considered in all populations who have high prevalence of CVD.

Phytoestrogens possess a weak antioxidant activity on low density lipoprotein in contrast to the flavonoid quercetinin vitroin postmenopausal women

BACKGROUND

Phytoestrogens are a family of plant-derived compounds with weak estrogenic and antiestrogenic properties. The antioxidant capacity of phytoestrogens has been proposed as one of the important mechanisms that explain their health benefits.

OBJECTIVE

To determine the in vitro potency of three phytoestrogens, ubiquitous in food, (biochanin A, daidzein and genistein) as antioxidants of low density lipoprotein (LDL) and to compare them with the well-established antioxidant actions of estradiol and quercetin, an ubiquitous flavonoid which is found in high concentration in onions, tea and berries.

METHODS

LDL was isolated by ultracentrifugation from the plasma of ten healthy postmenopausal women who were not on hormone therapy. Aliquots containing 0.5 mg of protein were incubated for 4 h with CuSO4 15 micromol/l to induce oxidative stress and with one of the five compounds studied: estradiol, quercetin, biochanin A, daidzein, and genistein, in doses of 0, 5, 15, 50, 500, 1000 and 2000 micromol/l. In addition, we studied the combined effect of estradiol 1 micromol/l plus quercetin 1 micromol/l, comparing their antioxidant action with that of each compound separately. Malonaldehyde (MDE nmol/ mg protein) was measured as a marker of LDL oxidation.

RESULTS

Estradiol and quercetin induced a dose-dependent decrease in MDE concentration (p < 0.01). Comparing the areas under the curve, the antioxidant effect of quercetin was 8 times higher than the one observed with estradiol (p < 0.01). A 50% decrease in MDE was reached by quercetin at a concentration of 3.4 micromol/l, estradiol at 29 micromol/l, genistein at 280 micromol/l, biochanin at 1312 mmol/l and daidzein at 8007 mmol/l. Estradiol 1 micromol/l and quercetin 1 micromol/l did not modify MDE generation separately, but, when incubated combined, there was a significant decrease of MDE (p < 0.02).

CONCLUSION

The phytoestrogens studied showed a weak antioxidant activity in vitro. The flavonoid quercetin, in contrast, showed the most potent antioxidant activity in vitro, higher than estradiol. Estradiol and quercetin showed additive antioxidant activity. We speculate that different compounds with variable antioxidant effects could amplify their antioxidant capacity when acting combined.

Role of plasma lipoproteins in the transport of the soyabean isoflavones daidzein and daidzein-7-O-beta-D-glucoside

Isoflavone intake is associated with various properties beneficial to human health which are related to their antioxidant activity, for example, to their ability to increase LDL oxidation resistance. However, the distribution of isoflavones among plasma lipoproteins has not yet been elucidated in vivo. Therefore, the objective of the present study was to investigate the association between daidzein (DAI) and lipoproteins in human plasma upon administration of the aglycone and glucoside form. Five men aged 22-30 years participated in a randomised, double-blind study in cross-over design. After ingestion of DAI and daidzein-7-O-beta-D-glucoside (DG) (1 mg DAI aglycone equivalents/kg body weight) blood samples were drawn before isoflavone administration as well as 1, 2, 3, 4.5, 6, 8, 10, 12, 24 and 48 h post-dose. Concentrations of DAI in the different lipoprotein fractions (chylomicrons, VLDL, LDL, HDL) and in the non-lipoprotein fraction were analysed using isotope dilution capillary GC/MS. The lipoprotein fraction profiles were similar for all subjects and resembled those obtained for plasma in our previously published study. The lipoprotein distribution based on the area under the concentration-time profiles from 0 h to infinity in the different fractions were irrespective of the administered form: non-lipoprotein fraction (53%) > LDL (20%) > HDL (14%) > VLDL (9.5%) > chylomicrons (2.5%). Of DAI present in plasma, 47 % was associated to lipoproteins. Concentrations in the different lipoprotein fractions as well as in the non-lipoprotein fraction were always higher after the ingestion of DG than of DAI. Taken together, these results demonstrate an association between isoflavones and plasma lipoproteins in vivo.

Effects of soy consumption on oxidative stress, blood homocysteine, coagulation factors, and phosphorus in peritoneal dialysis patients

OBJECTIVE

We studied the effects of soy consumption on oxidative stress, blood homocysteine, coagulation factors, and phosphorus in peritoneal dialysis patients.

DESIGN

This was an unblinded, randomized clinical trial.

SETTING

This study involved peritoneal dialysis centers in Tehran, Iran.

PATIENTS

We included 40 peritoneal dialysis patients (20 males and 20 females).

INTERVENTION

Peritoneal dialysis patients were randomly assigned to either a soy or control group. Patients in the soy group received 28 g/day textured soy flour (containing 14 g of soy protein) for 8 weeks, whereas patients in the control group received their usual diet, without any soy.

MAIN OUTCOME MEASURES

Blood oxidized low-density lipoprotein (ox-LDL), homocysteine, phosphorus, fibrinogen concentrations, and the activities of coagulation factors VII, IX, and X were measured at baseline and at the end of week 8 of the study.

RESULTS

The percentage of plasma coagulation factor IX activity decreased significantly by 17% in the soy group at the end of week 8 compared with baseline (P < .01), and the reduction was significant compared with the control group (P < .05). There were no significant differences between the two groups in mean changes of blood ox-LDL, homocysteine, phosphorus, fibrinogen concentrations, and the activities of coagulation factors VII and X.

CONCLUSION

Soy consumption reduces plasma coagulation factor IX activity, which is a risk factor for thrombosis in peritoneal dialysis patients.

Reprint of The nature and utility of the phytoestrogens: a review of the evidence

Non-prescription remedies are becoming increasingly popular particularly amongst postmenopausal who in this market are the largest consumers. Phytoestrogens are a large family of plant derived molecules possessing various degrees oestrogen like activity. Food or food supplements containing phytoestrogen are often been advocated as an alternative to hormonal replacement therapy (HRT) in women with contraindications to the use of conventional oestrogen replacement, or simply wanting a more 'natural' alternatives. There have been several studies performed with phytoestrogen in various aspects of the postmenopausal women health. Results have been sometimes conflicting and difficult to interpret. The lack of knowledge of what precisely is the active ingredient, its minimally effective doses, the lack of standardisation of the preparations used as well as the large individual variability of metabolism of precursors introduced with the diet may all have played a role in confusing the issue about effectiveness of these compounds. Phytoestrogen fall in the gray area between food and drugs hence in spite of the vast public interest, there are no interests in company producing these supplements in investing in research from which they will not exclusively benefit from. It is difficult for the physician to know how to advise patients on this matter. In this paper we critically review the clinical data available to date in an attempt to answer some of the most commonly asked questions about dose and type of phytoestrogens supplementation most likely to be effective in different aspects of climacteric woman health.

A casein diet added isoflavone-enriched soy protein favorably affects biomarkers of steatohepatitis in obese Zucker rats

OBJECTIVE

Dietary supplementation of a soy protein enriched with isoflavones (HDI) has been shown to improve fatty liver in obese rats. The main objective of this study was to investigate whether HDI would influence the inflammatory status in livers of obese rats with fatty liver.

METHODS

Male obese Zucker fa/fa rats were fed casein (controls) or casein supplemented with HDI (containing 4.00 g of genistein and 4.50 g of daidzein per kilogram of diet) for 6 wk.

RESULTS

The HDI-fed rats had a markedly lower hepatic concentration of triacylglycerol when compared with controls. The decreased aspartate transaminase/alanine transaminase ratio in plasma, together with lower circulating levels of alkaline phosphatase and bile acids after HDI feeding, implied an improved hepatitis. This was supported by decreased plasma and hepatic mRNA levels of tumor necrosis factor-alpha, lower plasma levels of interleukin-1beta and monocyte chemoattractant protein-1, and an increased anti-inflammatory fatty acid index in plasma. HDI also seemed to protect the rats from oxidative damage, because the level of lipid peroxides in triacylglycerol-rich lipoproteins after in vitro copper oxidation was lower for HDI-fed rats when compared with controls.

CONCLUSION

These results show that isoflavone-enriched soy protein favorably affects biomarkers of hepatic inflammation in obese Zucker fa/fa rats with fatty liver. Thus, dietary soy proteins enriched in isoflavones may be a promising agent to improve steatohepatitis in patients.

Soy-tibolone combination - effect on lipids in postmenopausal monkeys and women

OBJECTIVES

To determine whether co-administration of soy during tibolone treatment would prevent tibolone-induced dyslipoproteinemia in postmenopausal monkeys and women.

METHODS

Surgically postmenopausal cynomolgus monkeys (n = 18) were assigned randomly to one of four dietary regimens in a Latin Square crossover design, such that all animals received all diets for 14 weeks with a 4-week washout period: (1) casein/lactalbumin (CL); (2) tibolone (Tib, 1.25 mg/day women's equivalent); (3) soy (138 mg isoflavones/day women's equivalent); (4) Soy + Tib. Postmenopausal women on tibolone treatment were randomized to receive soy powder (52 g of soy protein containing 112 mg isoflavones) or placebo (containing 52 g of milk protein) daily in a crossover trial for 8 weeks with a 4-week washout period.

RESULTS

Monkeys given Tib alone had approximately 14% increase in plasma LDL + VLDL-C; whereas those given soy combined with tibolone had significant ( approximately 22%) reductions. Tib treated monkeys had reductions in plasma HDL-C of about 48% vs. no reductions in Soy + Tib. In postmenopausal women using tibolone, soy reduced plasma LDL-C concentrations by approximately 10% from baseline without a change in HDL-C.

CONCLUSIONS

Co-administration of soy during tibolone treatment improved the lipoprotein profile in both monkeys and women; however, the effects were more robust in monkeys.

Systematic review, meta-analysis and regression of randomised controlled trials reporting an association between an intake of circa 25 g soya protein per day and blood cholesterol

AIMS

To determine the effect of a daily intake of circa 25 g soya protein on blood lipids in adults with normal or mildly elevated cholesterolaemia.

METHODS

Medline and other scientific databases were searched to identify randomised controlled trials (RCTs); these were systematically reviewed against pre-determined criteria. Eligible RCTs evaluated the effect of 25 g (range 15-40 g) soya protein on measures of blood lipids. Results from RCTs were pooled using standard meta-analysis methods.

RESULTS

Thirty studies containing 42 treatment arms (n=2913), with an average soya protein intake of 26.9 g met the inclusion criteria. Soya protein inclusion led to reductions in standard difference in mean low density lipoprotein (LDL), total cholesterol and blood triglycerides of 0.23 mmol/L (95% confidence interval (CI) -0.160 to -0.306, p<0.0001), 0.22 mmol/L (95% CI -0.142 to -0.291, p<0.0001) and 0.08 mmol/L (95% CI -0.004 to -0.158, p=0.04), respectively. There was no effect on mean difference in apolipoprotein A (ApoA), but ApoB was reduced by 0.021 g/L (p=0.01) in the soya group. Meta-regression analysis indicated no dose response relationship between soya protein intake in the range of 15-40 g and standard difference in LDL or HDL. All data were tested for heterogeneity and none identified.

CONCLUSIONS

The inclusion of modest amounts soya protein (ca. 25 g) into the diet of adults with normal or mild hypercholesterolaemia resulted in small, highly significant reductions in total and LDL cholesterol, equivalent to ca. 6% LDL reduction. This practically achievable intake, particularly when combined with other dietary measures, can make a useful contribution to blood cholesterol management.

Pasta naturally enriched with isoflavone aglycons from soy germ reduces serum lipids and improves markers of cardiovascular risk

Most studies of soy and cholesterol have tested foods made from purified soy proteins containing mainly isoflavone glycosides. Fermented soy foods have mainly isoflavone aglycons and account for a high proportion of the soy protein source in Asia, where there is an inverse relationship between soy intake and serum cholesterol. The aim of this study was to compare a novel soy germ pasta, naturally enriched in isoflavone aglycons as a result of the manufacturing process, with conventional pasta for effects on serum lipids and other cardiovascular risk markers. In this randomized, controlled, parallel study design of 62 adults with hypercholesterolemia who consumed a Step II diet that included one 80-g serving/d of pasta, we measured serum lipids, high sensitivity C-reactive protein (hsCRP), urinary isoprostanes, and brachial artery flow-mediated vasodilatation at baseline and after 4 and 8 wk. The pasta delivered 33 mg of isoflavones and negligible soy protein and led to a serum isoflavone concentration of 222 +/- 21 nmol/L; 69% of subjects were equol producers. Soy germ pasta reduced serum total and LDL cholesterol by 0.47 +/- 0.13 mmol/L (P = 0.001) and 0.36 +/- 0.10 mmol/L (P = 0.002) more than conventional pasta, representing reductions from baseline of 7.3% (P = 0.001) and 8.6% (P = 0.002), respectively. Arterial stiffness (P = 0.003) and hsCRP (P = 0.03) decreased and improvements in all the above risk markers were greatest in equol producers. All measures returned to baseline when patients were switched to conventional pasta. In conclusion, pasta naturally enriched with isoflavone aglycons and lacking soy protein had a significant hypocholesterolemic effect beyond a Step II diet and improved other cardiovascular risk markers.

Dietary soya intake alters plasma antioxidant status and lipid peroxidation in postmenopausal women with the metabolic syndrome

Postmenopausal women with the metabolic syndrome are at high risk of oxidative stress. Several studies have suggested possible antioxidant properties of soya, but little evidence is available regarding the effect of soya on oxidative stress in postmenopausal women with the metabolic syndrome. The objective of the present study was to determine the effects of soya consumption on plasma total antioxidant capacity (TAC) and malondialdehyde (MDA) level in postmenopausal women with the metabolic syndrome. A randomised cross-over trial was undertaken on forty-two postmenopausal women with the metabolic syndrome. Participants were randomly assigned to consume a control (Dietary Approaches to Stop Hypertension; DASH) diet, a soya protein diet, or a soya nut diet, each for 8 weeks. Red meat in the DASH diet (one serving per d) was replaced by soya protein in the soya protein period and by soya nuts in the soya nut period. Significant differences between the end values of the control diet, soya protein diet and soya nut diet were seen for MDA (0.70, 0.64 and 0.63 mumol/l; global P < 0.01). The results also showed a significant difference between the end values for TAC (1950, 2030 and 2110 mumol/l, respectively; P < 0.01). The difference from control for TAC was +4.5 % (P < 0.01) in the soya nut period and +5.8 % (P < 0.01) in the soya protein regimen. Both soya nuts and soya protein decreased MDA significantly compared with the control diet (difference from control was - 7.9 % (P < 0.01) in the soya nut period and - 9.4 % (P < 0.01) in the soya protein diet). We conclude that soya consumption reduces plasma MDA and increases plasma TAC levels in postmenopausal women with the metabolic syndrome.

Soy isoflavones reduce electronegative low-density lipoprotein (LDL(-)) and anti-LDL (-) autoantibodies in experimental atherosclerosis

BACKGROUND

Isoflavones present in soybean may contribute to soy atheroprotective effects.

AIM OF THE STUDY

To investigate the effect of soy isoflavones supplementation on the formation of electronegative LDL (LDL(-)) and its autoantibodies in blood plasma and aortic atheromas of rabbits fed an atherogenic casein-based diet enriched with isoflavones.

METHODS

New Zealand male rabbits (n = 15) were fed an atherogenic diet (27% casein) supplemented with isoflavones (0.73 or 7.3 mg of isoflavones/kg/day, Low and High Iso groups, respectively) for 180 days. Monthly, blood samples were collected after 12-15 h fasting and at 180 days of treatment all animals were sacrificed. Isoflavones were analyzed in plasma and urine samples by HPLC. LDL(-) in plasma and atheromas was detected by ELISA and immunohistochemistry, respectively, with a monoclonal antibody reactive to LDL(-). Autoantibodies reactive to LDL(-) were analyzed in plasma and aorta by ELISA.

RESULTS

Low and High Iso groups had decreased LDL-cholesterol, increased HDL-cholesterol and lower levels of LDL(-) in blood plasma and aortic atherosclerotic lesions than the non-supplemented Control group. IgG autoantibodies reactive to LDL(- )were higher in plasma of the Control group in comparison with the High and Low Iso groups. In contrast, the aortas from animals that consumed isoflavones showed higher levels of IgG reactive to LDL(- )than the Control group.

CONCLUSION

Soy isoflavones showed hypolipidemic effects and decreased the pro-inflammatory LDL(-) subfraction in blood plasma and aorta of hypercholesterolemic rabbits.

Safety and antioxidant effects of a modest soy protein intervention in hemodialysis patients

Antioxidant/anti-inflammatory effects of isoflavone-containing soy protein could partly explain why hemodialysis patients in Japan tend to outlive U.S. hemodialysis patients. However, a safety concern is that dialysis patients do not clear isoflavones well. A low-dose intervention with high isoflavone soy protein (25 g protein, four times a week for 4 weeks) was tested in 17 U.S. hemodialysis patients (eight given soy protein, nine given whey protein as a control). Soy protein intake produced no harmful effects based on a typical battery of blood safety tests. Post-treatment isoflavone levels, though high, were similar to those reported after a single 20-g soy protein intake by dialysis patients. In addition, intake of soy, but not whey, reduced plasma values for oxidized low-density lipoprotein, a risk factor for cardiovascular disease, which is a common mortality cause in hemodialysis patients. Three other measures of oxidant stress and/or inflammation were unchanged by the modest high isoflavone soy protein intervention. In conclusion, in hemodialysis patients, a fairly short, low intake level intervention with high isoflavone soy protein produced no obvious harm, and produced one potentially beneficial effect. This justifies tests of higher-dose, longer interventions with soy protein in hemodialysis patients.

Dietary antioxidants in preventing atherogenesis

Several naturally occurring constituents have received considerable attention because of their potential antioxidant activity. Consuming a diet rich in natural antioxidants has been associated with prevention from and/or treatment of atherosclerosis. Bioactive components of food, which are of special interest, include the Vitamins E and C, polyphenols, carotenoids-mainly lycopene and beta-carotene, and coenzyme Q10, featured by antioxidant properties. Antioxidant therapy is supposed to be effective in the early stages of atherosclerosis by preventing LDL oxidation and the oxidative lesion of endothelium. This review focuses on the effect of dietary antioxidants pertained to LDL oxidation and to the vascular endothelial dysfunction. Now that the human genome has been completely sequenced, genetic factors involved in oxidation may open new horizons to identify persons at risk for cardiovascular disease, allowing effective dietary intervention strategies to recover normal homeostasis and to prevent diet-related implications. On this basis, current studies on the action of selected antioxidant nutraceuticals on the activity of transcription factors, such as final targets in the signal transduction cascade and gene regulation, may emerge into new treatment concepts.

Effects of soy or milk protein durign a high-fat feeding challenge on oxidative stress, inflammation, and lipids in healthy men

Soy isoflavones may impede atherogenic processes associated with cardiovascular disease. Research suggests that the postprandial generation of TG-rich remnants contributes to the development of atherosclerosis. The purpose of the current study was to determine if 39 g soy (85 mg aglycone isoflavones, treatment) compared with 40 g milk protein (0 mg aglycone isoflavones, control) in combination with a high-fat meal can modify postprandial, atherogenic-associated events and biomarkers for oxidative stress, inflammation, and thrombosis. Fifteen healthy men (20-47 yr) participated in a double-blind cross-over meal-challenge study occurring on two nonconsecutive days. The study meals consisted of two high-fat apple muffins consumed with either a soy or milk shake (229 mL, 41% fat, 41% carbohydrate, and 18% protein). Blood samples were obtained at baseline (fasted) and hours two, four, and six postprandial. Plasma TG significantly increased in both treatment and control meal challenges compared with baseline. There were no significant differences (P > 0.05) between treatment (soy) and control (milk) for ex vivo copper-induced LDL oxidation, serum C-reactive protein, serum interleukin-6 (IL-6), serum fibrinogen, or plasma lipids (total cholesterol, HDL, LDL, TG). IL-6-concentrations significantly decreased as a function of time during either meal challenge (P = 0.005). These data suggest that consumption of soy or milk protein in conjunction with a high-fat meal does not acutely modify postprandial oxidative stress, inflammation, or plasma lipid concentrations in young, healthy men.

Menopause: a review on the role of oxygen stress and favorable effects of dietary antioxidants

Menopause is often accompanied by hot flashes and degenerative processes such as arteriosclerosis and atrophic changes of the skin that suggest an acceleration of aging triggered by estrogen lack. Therefore, hormone replacement therapy (HRT) has been considered the most suitable treatment for the above symptoms and processes. However, because of the possible serious side effects of HRT (especially the increased risk of thrombo-embolic accidents and breast cancer) there is a growing demand for alternative treatments of the symptoms and pathological processes associated with menopause. In agreement with the above, we review research that supports the concept that oxygen stress contributes to menopause and that some of its physiopathological effects may be prevented and/or treated improving the antioxidant defense of menopausic and postmenopausic women. Accordingly, a selection of micronutrients may be useful as a dietary supplement for protection against the decline of physiological functions caused by age-related oxygen stress. Since aging is accompanied by a progressive oxidation of the physiological sulfur pool, we emphasize the role of the vitamins B that help to maintain the GSH/GSSG ratio in its normal reduced state. Nutritional supplements should also include the key antioxidant vitamins C and E, as well as beta-carotene and the mineral micronutrients found in the oxygen radical-detoxifying enzymes glutathione peroxidase and superoxide dismutase. Moreover, the reviewed data suport the concept that other antioxidants such as lipoic acid and the precursors of glutathione thioproline (TP) and l-2-oxothiazolidine-4-carboxylic acid (OTC), as well as the soy isoflavones and the "coantioxidants" of an hydroalcoholic extract of Curcuma longa may help to prevent antioxidant deficiency with resulting protection of mitochondria against premature oxidative damage with loss of ATP synthesis and especialized cellular functions. Therefore, the administration under medical advice of synergistic combinations of some of the above mentioned antioxidants in the diet as well as topically (for skin protection) may have favorable effects on the health and quality of life of women, especially of those who cannot be treated with HR, suffer high levels of oxygen stress, and do not consume a healthy diet that includes five daily rations of fresh fruit and vegetables.

Complementary and alternative therapeutic approaches in patients with early breast cancer: a systematic review

Complementary and alternative medicine (CAM) is becoming increasingly popular, particularly among patients with breast cancer. We have done a systematic review of studies published between 1995 and February 2005, identified through a comprehensive search. CAM encompasses a wide range of treatment modalities, including dietary and vitamin supplements, mind-body approaches, acupuncture, and herbal medicines. The objectives of CAM treatments are diverse: reduction of therapy-associated toxicity, improvement of cancer-related symptoms, fostering of the immune system and even direct anticancer effects. Clinical trials have generated few or no data on the efficacy of CAM, whether regarding disease recurrence, survival, overall quality of life or safety. Some CAM methods may even have adverse effects or reduce the efficacy of conventional treatment. The primary justification for CAM is based on empirical evidence, case studies, and hypothetical physiological effects. We conclude that available data on CAM modalities in the treatment of early-stage breast cancer does not support their application.

Soy isoflavone and ascorbic acid supplementation alone or in combination minimally affect plasma lipid peroxides in healthy postmenopausal women

The objective of this study was to assess synergistic antioxidant properties of vitamin C and isoflavones. The design was a placebo-controlled crossover trial: 500 mg vitamin C, 5 mg/kg body weight isoflavones, 500 mg vitamin C plus 5 mg/kg body weight isoflavones, or placebo. Total lipid peroxides, plasma vitamin C, and blood pressure were measured. Eight of 10 healthy postmenopausal women completed the study. A multiple analysis of variance was performed and least-squares difference post-hoc test utilized to determine where differences occurred. Significance was defined as P <.05. There was a significant reduction in total lipid peroxides between baseline and isoflavone treatments (3.22+/-0.72 vs 2.47+/-0.82 nmol/mL, P <.05). Mean systolic blood pressure was higher during isoflavone intervention than placebo (117+/-14 vs 125+/-15 mm Hg, P= .042). Supplementation with vitamin C and isoflavones did not produce a synergistic antioxidant effect. A slight but significant increase in systolic blood pressure occurred with isoflavone supplementation. A larger study should be conducted to fully explore the potential interactions between these antioxidants.

Isoflavones and postmenopausal women: a critical review

Isoflavonic phytoestrogens, or isoflavones, constitute a class of phytoestrogens that have properties similar to selective estrogen receptor modulators, and have attracted a substantial degree of attention in recent years, particularly as a possible alternative to the conventional hormone replacement therapy regimens used by postmenopausal women. Despite great promise, it is difficult to make many specific recommendations about their use at the current time, in light of the many outstanding questions that hopefully will be answered in the future by focused interventional studies involving humans. Studies to date indicate that the use of isoflavones to address vasomotor symptoms provides at most small benefits beyond a placebo effect, and no benefit for genital atrophy. As for postmenopausal women whose primary concern is cardiovascular disease, the recommendation of the American Heart Association to include soy protein foods as part of an otherwise healthy diet is well justified, and similarly the substitution of supplements containing soy protein for animal protein can also be recommended. The use of purified isoflavone supplements not containing soy protein may have some cardiovascular benefits, but these appear to be less substantial in degree than those provided by soy protein with isoflavones. In particular, more research is needed to assess the effects of isoflavones on osteoporosis, for which no recommendation regarding isoflavones can be made based on the current data. Also, isoflavones should not be taken by postmenopausal women for the specific purpose of decreasing their risk of breast or endometrial cancer, although, at least for those without pre-existing disease or at high risk, it seems quite unlikely that isoflavone use is harmful in this regard.

Blood lipid and oxidative stress responses to soy protein with isoflavones and phytic acid in postmenopausal women

BACKGROUND

Postmenopausal women are at risk of cardiovascular disease (CVD) as a result of unfavorable blood lipid profiles and increased oxidative stress. Soy protein consumption may help protect against these risk factors.

OBJECTIVE

Our objective was to ascertain the effect of the soy protein components isoflavones and phytate on CVD risk in postmenopausal women.

DESIGN

In a double-blind 6-wk study, 55 postmenopausal women were randomly assigned to 1 of 4 treatments with soy protein (40 g/d) isolate (SPI): low phytate/low isoflavone (LP/LI); normal phytate/low isoflavone (NP/LI); low phytate/normal isoflavone (LP/NI); or normal phytate/normal isoflavone (NP/NI). Blood lipids (total, LDL, and HDL cholesterol and triacylglycerol) and oxidative stress indexes (protein carbonyls, oxidized LDLs, and 8-iso-prostaglandin-F(2alpha)) were measured at baseline and 6 wk.

RESULTS

The oxidative stress indexes were not significantly affected by either phytate or isoflavones. Phytate treatment had a minimal but nonsignificant effect in reducing protein carbonyls and 8-iso-prostaglandin-F(2alpha); the reductions were 6-8% and 4-6% in the NP/LI and NP/NI groups and 1-4% and 3-4% in the LP/LI and LP/NI groups, respectively. Similarly, circulating lipids were not significantly affected by either phytate or isoflavones. The decline in total (6%-7% compared with 2%-4%) and LDL (10%-11% compared with 3%-7%) cholesterol did not differ significantly between the normal- and low-isoflavone groups, respectively.

CONCLUSION

In postmenopausal women, neither phytate nor isoflavones in SPI have a significant effect of reducing oxidative damage or favorably altering blood lipids.

Soy, isoflavones and atherosclerosis

Consumption of soy protein is associated with a lower risk of cardiovascular disease in man, and reduced atherosclerosis in a variety of experimental animals. Although a portion of the cardiovascular protective effects appears to be due to reductions in plasma lipoprotein concentration, in most people the magnitude of this effect is relatively small. In many, but not all studies using animal models, the reduction in atherosclerosis is in part independent of changes in plasma lipids and lipoproteins. This implies that there may be a direct effect on the arterial wall of one or more of the components in soyprotein that reduces susceptibility to atherosclerosis. The most actively studied components of soy protein that may be responsible for these anti-atherogenic effects are the isoflavones and various protein factions. Extraction of isoflavones and other alcohol-soluble components from soy protein lowers, but does not eliminate its ability to reduce atherosclerosis. Surprisingly, in most studies, adding back the isoflavone-rich alcohol extract to the previously extracted soy protein, or to another protein, does not restore its lipoprotein lowering or anti-atherogenic properties. This implies that alcohol extraction either destroys an active component of soy, alters the structural integrity of the soy proteins, or disassociates a required isoflavone-soy protein complex. Understanding the mechanism of this effect is an important goal for future research. Likewise, the sites of action on the arterial wall, and the mechanisms by which various soy components act to reduce atherosclerosis are just now being studied. The recent demonstration that expression of estrogen receptor alpha is required for atheroprotection by soy protein provides important new mechanistic insight. Other properties of soy, including antioxidant, anti-inflammatory and potentially antithrombogenic properties need to be explored more mechanistically before the full potential of dietary soy protein for the protection from cardiovascular disease will be known.

Bioavailability and bioefficacy of polyphenols in humans. II. Review of 93 intervention studies

For some classes of dietary polyphenols, there are now sufficient intervention studies to indicate the type and magnitude of effects among humans in vivo, on the basis of short-term changes in biomarkers. Isoflavones (genistein and daidzein, found in soy) have significant effects on bone health among postmenopausal women, together with some weak hormonal effects. Monomeric catechins (found at especially high concentrations in tea) have effects on plasma antioxidant biomarkers and energy metabolism. Procyanidins (oligomeric catechins found at high concentrations in red wine, grapes, cocoa, cranberries, apples, and some supplements such as Pycnogenol) have pronounced effects on the vascular system, including but not limited to plasma antioxidant activity. Quercetin (the main representative of the flavonol class, found at high concentrations in onions, apples, red wine, broccoli, tea, and Ginkgo biloba) influences some carcinogenesis markers and has small effects on plasma antioxidant biomarkers in vivo, although some studies failed to find this effect. Compared with the effects of polyphenols in vitro, the effects in vivo, although significant, are more limited. The reasons for this are 1) lack of validated in vivo biomarkers, especially in the area of carcinogenesis; 2) lack of long-term studies; and 3) lack of understanding or consideration of bioavailability in the in vitro studies, which are subsequently used for the design of in vivo experiments. It is time to rethink the design of in vitro and in vivo studies, so that these issues are carefully considered. The length of human intervention studies should be increased, to more closely reflect the long-term dietary consumption of polyphenols.

Soy isoflavone intake lowers serum LDL cholesterol: a meta-analysis of 8 randomized controlled trials in humans

Clinical trials have noted hypocholesterolemic effects of soy protein intake, but the components responsible are not known. This meta-analysis of 8 randomized controlled trials was conducted to more precisely evaluate the effects of isoflavones on blood LDL cholesterol concentration independently of soy protein level. PubMed was searched for English-language "randomized controlled trial" articles published from 1966 to 2003 that described the effects of soy protein isolate (SPI) intake with measured isoflavone levels on blood lipids in humans using the search terms "soy protein," "isoflavones," and "cholesterol." From 31 articles identified by the search, 8 articles (with 10 low vs. high isoflavone comparisons) were selected for the meta-analysis. Subjects in each comparison consumed similar dietary fat, cholesterol, and fiber; the reported body weight of subjects did not change significantly during treatment. Serum LDL cholesterol concentration in subjects who consumed SPI (mean 50 g/d) with high isoflavone content (mean intake 96 mg/d) decreased by 0.15 mmol/L (95% CI: 0.08 to 0.23 mmol/L; P < 0.0001) compared with those who consumed the same SPI level with low isoflavone content (mean intake 6 mg/d). Decreases in serum LDL cholesterol concentration in hypercholesterolemic and normocholesterolemic subjects were 0.18 mmol/L (95% CI: 0.01 to 0.35 mmol/L; P = 0.03) and 0.14 mmol/L (95% CI: 0.06, 0.23 mmol/L; P = 0.0008), respectively. With identical soy protein intake, high isoflavone intake led to significantly greater decreases in serum LDL cholesterol than low isoflavone intake, demonstrating that isoflavones have LDL cholesterol-lowering effects independent of soy protein.

Dietary Intake and Coronary Heart Disease: A Variety of Nutrients and Phytochemicals Are Important

Until quite recently, the dietary focus on prevention of coronary heart disease (CHD) has been almost exclusively centered on reducing intake of cholesterol, total fat, and saturated fat. The food industry responded vigorously with low-fat products, some of which are helpful, particularly low-fat dairy products, but others that are less so, due to increases in refined carbohydrate content. Recent research shows that a variety of foods contribute to protection against CHD, including certain types of fatty acids, and a variety of components in fruit and vegetables, whole grains, and nuts. In particular, there is now an emphasis on reducing not only saturated fat, but also trans fat, whereas mono and omega-3 fatty acids have been shown to be protective. Many new studies have shown a link between intake of fruit and vegetables and whole grains and protection against CHD. This has been ascribed to their fiber, vitamin, mineral, and phytochemical content. In particular, there is accumulating evidence of protective effects for folate, vitamin B(6), vitamin B(12), vitamin E, vitamin C, flavonoids, and phytoestrogens. New recommendations to prevent heart disease require a greater focus on total dietary pattern with a return to the use of a variety of minimally processed foods.

Influence of soya-based infant formula consumption on isoflavone and gut microflora metabolite concentrations in urine and on faecal microflora composition and metabolic activity in infants and children

The urinary excretion of soya isoflavones and gut microflora metabolites was investigated in infants and children who had been fed soya-based infant formulas in early infancy. These infants and children were compared with cows'-milk formula-fed controls, to determine at what age gut microflora metabolism of daidzein to equol and/or O-desmethylangolensin (O-DMA) was established, and whether exposure to isoflavones in early infancy influences their metabolism at a later stage of development. Sixty infants and children (aged 4 months-7 years) participated in the study; thirty in each of the soya and control groups. There were four age groups. These were: 4-6 months (seven in the soya group and seven in the control group); 7-12 months (seven in the soya group and nine in the control group); 1-3 years (six in the soya group and eight in the control group); 3-7 years (ten in the soya group and six in the control group). Urine samples were collected to measure isoflavonoids by MS, and faecal samples were collected to measure gut-health-related bacterial composition, by fluorescent in situ hybridisation with oligonucleotide probes, and metabolic activity. A soya challenge (typically a soya yoghurt alternative product containing 4.8 g soya protein and on average 22 mg total isoflavones) was given to control-group infants (>6 months) and children, and also to soya-group children that were no longer consuming soya, to determine their ability to produce equol and/or O-DMA. Urinary genistein, daidzein and glycitein were detected in all infants (4-6 months) fed soya-based infant formula; O-DMA was detected in 75 % of infants but equol was detected in only 25 %. In the controls (4-6 months), urinary isoflavonoids were very low or not detected. In the older age groups (7 months-7 years), O-DMA was found in the urine samples of 75 % of the soya group and 50 % of the controls, after the soya challenge. Equol excretion was detected in 19 % of the soya-group infants and children, and in only 5 % of the controls. However, in the oldest (3-7 years) children, the proportion excreting O-DMA and equol was similar in both groups. Faecal bacterial numbers for bifidobacteria (P<0.001), bacteroides and clostridia (P<0.05) were significantly lower for the soya group compared with the control group. There appears to be no lasting effect of early-life isoflavone exposure on isoflavone metabolism.

Soy protein with isoflavones has favorable effects on endothelial function that are independent of lipid and antioxidant effects in healthy postmenopausal women

BACKGROUND

Controversy exists about the ability of soy protein and isoflavones to modulate vascular reactivity and biochemical cardiovascular disease risk markers in healthy, normolipidemic postmenopausal women.

OBJECTIVE

The objective was to investigate whether the consumption of soy protein with isoflavones would result in improved vascular reactivity and decreased biochemical markers of endothelial dysfunction and inflammation, independent of enhanced lipid and antioxidant effects.

DESIGN

Healthy postmenopausal women (n = 28) were enrolled in a randomized, double-blind, crossover study, and they consumed 25 g of 3 protein products/d for 6 wk each, with intervening washout periods. The products were isolated soy protein with isoflavones, ethanol-washed isolated soy protein with trace isoflavones, and total milk protein, which supplied 107, 2, and 0 mg total isoflavone (aglycone) units/d, respectively. We studied vascular function by using brachial artery reactivity values, plasma concentrations of vasoactive factors, endothelial inflammatory markers, and plasma isoflavone concentrations. The resistance of whole plasma and isolated LDL to copper-mediated oxidation was measured by conjugated diene formation.

RESULTS

Postocclusion peak flow velocity of the brachial artery was significantly (P = 0.03) lower after treatment with isolated soy protein with isoflavones, which is consistent with a vasodilatory response, than after treatment with total milk protein. Plasma isoflavones and metabolites were significantly (P < 0.01) higher after treatment with isolated soy protein with isoflavones. There were no significant changes in biochemical cardiovascular disease risk markers or conjugated diene formation between the 3 dietary groups.

CONCLUSION

Daily consumption of soy protein with isoflavones can result in positive vascular effects that are independent of lipid and antioxidant effects in healthy postmenopausal women.

The clinical importance of the metabolite equol-a clue to the effectiveness of soy and its isoflavones

Equol [7-hydroxy-3-(4'-hydroxyphenyl)-chroman] is a nonsteroidal estrogen of the isoflavone class. It is exclusively a product of intestinal bacterial metabolism of dietary isoflavones and it possesses estrogenic activity, having affinity for both estrogen receptors, ERalpha and ERbeta. Equol is superior to all other isoflavones in its antioxidant activity. It is the end product of the biotransformation of the phytoestrogen daidzein, one of the two main isoflavones found in abundance in soybeans and most soy foods. Once formed, it is relatively stable; however, equol is not produced in all healthy adults in response to dietary challenge with soy or daidzein. Several recent dietary intervention studies examining the health effects of soy isoflavones allude to the potential importance of equol by establishing that maximal clinical responses to soy protein diets are observed in people who are good "equol-producers." It is now apparent that there are two distinct subpopulations of people and that "bacterio-typing" individuals for their ability to make equol may hold the clue to the effectiveness of soy protein diets in the treatment or prevention of hormone-dependent conditions. In reviewing the history of equol, its biological properties, factors influencing its formation and clinical data, we propose a new paradigm. The clinical effectiveness of soy protein in cardiovascular, bone and menopausal health may be a function of the ability to biotransform soy isoflavones to the more potent estrogenic isoflavone, equol. The failure to distinguish those subjects who are "equol-producers" from "nonequol producers" in previous clinical studies could plausibly explain the variance in reported data on the health benefits of soy.

Flavonoids and steroid hormone-dependent cancers

Steroid-hormone dependent cancers, including those of the breast, prostate and colon, are leading causes of morbidity and mortality in western countries. In rural Asian areas, these diseases are relatively uncommon. Dietary factors, including low consumption of fruit, vegetables and soy in the west have been shown in various epidemiologic studies as reasons for these differences. This review discusses flavonoids, one component of these plant foods that is being investigated for their role in chemoprevention. Epidemiological, in vitro, animal and human studies shall be explored to look at mechanisms involved, including steroid hormone activity, effects on cell growth, antioxidant activities, inhibition of chemical carcinogenesis and influences on modulators of cancer risk. Although the in vitro and animal models point to several pathways by which flavonoids may reduce incidence of these cancers, the clinical data are still relatively lacking. More research is needed to determine how best to use foods containing these compounds to reduce steroid hormone-dependent cancer risk.

Effects of high- and low-isoflavone soyfoods on blood lipids, oxidized LDL, homocysteine, and blood pressure in hyperlipidemic men and women

BACKGROUND

Many of the benefits of soy have been attributed to soy isoflavones.

OBJECTIVE

The objective was to determine the effects of high- and low-isoflavone soy-protein foods on both lipid and nonlipid risk factors for coronary artery disease (CAD).

METHODS

Forty-one hyperlipidemic men and postmenopausal women participated in a study with three 1-mo diets: a low-fat dairy food control diet and high- (50 g soy protein and 73 mg isoflavones daily) and low- (52 g soy protein and 10 mg isoflavones daily) isoflavone soyfood diets. All 3 diets were very low in saturated fat (< 5% of energy) and cholesterol (< 50 mg/d). Fasting blood samples were drawn and blood pressure was measured at the start and end of each diet.

RESULTS

No significant differences were seen between the high- and low-isoflavone soy diets. Compared with the control diet, however, both soy diets resulted in significantly lower total cholesterol, estimated CAD risk, and ratios of total to HDL cholesterol, LDL to HDL cholesterol, and apolipoprotein B to A-I. No significant sex differences were observed, except for systolic blood pressure, which in men was significantly lower after the soy diets than after the control diet. On the basis of blood lipid and blood pressure changes, the calculated CAD risk was significantly lower with the soy diets, by 10.1 +/- 2.7%.

CONCLUSION

Substitution of soyfoods for animal products, regardless of isoflavone concentration, reduces the CAD risk because of both modest reductions in blood lipids and reductions in oxidized LDL, homocysteine, and blood pressure.

The nature and utility of the phytoestrogens: a review of the evidence

Non-prescription remedies are becoming increasingly popular particularly amongst postmenopausal who in this market are the largest consumers. Phytoestrogens are a large family of plant derived molecules possessing various degrees oestrogen like activity. Food or food supplements containing phytoestrogen are often been advocated as an alternative to hormonal replacement therapy (HRT) in women with contraindications to the use of conventional oestrogen replacement, or simply wanting a more 'natural' alternatives. There have been several studies performed with phytoestrogen in various aspects of the postmenopausal women health. Results have been sometimes conflicting and difficult to interpret. The lack of knowledge of what precisely is the active ingredient, its minimally effective doses, the lack of standardisation of the preparations used as well as the large individual variability of metabolism of precursors introduced with the diet may all have played a role in confusing the issue about effectiveness of these compounds. Phytoestrogen fall in the gray area between food and drugs hence in spite of the vast public interest, there are no interests in company producing these supplements in investing in research from which they will not exclusively benefit from. It is difficult for the physician to know how to advise patients on this matter. In this paper we critically review the clinical data available to date in an attempt to answer some of the most commonly asked questions about dose and type of phytoestrogens supplementation most likely to be effective in different aspects of climacteric woman health.

Endocrine disruptors: a new scientific role for clinical pharmacologists? Impact on human health, wildlife, and the environment

It is important for the clinical pharmacologist to understand the potential human health implications of exposure to environmental chemicals that may act as hormonally active agents. It is necessary to have an understanding of how pharmaceutical and personal care products and other chemicals affect the ecosystem of planet Earth and to understand how they may negatively contribute to human disease. Clinical pharmacologists must understand the various definitions of endocrine disruptors and be able to "decipher" these terms for their patients. Understanding the need for the EPA endocrine disruptor screening program and possessing knowledge of the screening assays used to assess endocrine activity potential are two essential components relevant to the topic of endocrine disruptors. Clinical pharmacologists have an opportunity to play an important role in resolving the question of what role endocrine disruptors play in initiating human disease since some scientists argue that the present evidence is not compelling. Clinical pharmacologists can also play an important role in the evaluation of the risk assessment and use of risk management and risk communication tools required to address public health concerns related to actions of endocrine disruptors. It is important that clinical pharmacologists work with veterinary clinical pharmacologists, toxicologists, industrial chemists, regulators, the scientific community, the general public, and environmental groups to understand the impact of endocrine disruptors on human health, wildlife, and the environment with an ultimate goal to minimize and/or alleviate the unwanted, detrimental effects of the endocrine disruptors.

Soy isoflavones--benefits and risks from nature's selective estrogen receptor modulators (SERMs)

Phytoestrogens have become one of the more topical areas of interest in clinical nutrition. These non-nutrient bioactive compounds are ubiquitous to the plant kingdom and possess a wide range of biological properties that contribute to the many different health-related benefits reported for soy foods and flaxseeds--two of the most abundant dietary sources of phytoestrogens. Reviewed is the recent knowledge related to their pharmacokinetics and clinical effects, focusing mainly on isoflavones that are found in high concentrations in soy foods. Arguments are made for considering soy isoflavones as natural selective estrogen receptor modulators (SERMs) based upon recent data of their conformational binding to estrogen receptors. Rebuttal is made to several key and important issues related to the recent concerns about the safety of soy and its constituent isoflavones. This article is not intended to be a comprehensive review of the literature but merely highlight recent research with key historical perspectives.

Effects of natural products and nutraceuticals on steroid hormone-regulated gene expression

BACKGROUND

There is an increasing trend in the use of complementary and alternative therapies to treat or prevent hormonally dependent pathologies. Methods determined whether several of these natural products and nutraceuticals, commonly taken for hormone-related effects, possess steroid hormone activity. The agonist and antagonist estrogenic, androgenic, and progestational activities of 20 natural products and nutraceuticals were assessed using an in vitro tissue culture indicator system. Two steroid-regulated proteins (pS2 and prostate-specific antigen [PSA]) were quantified, using ELISA-type immunoassays, as markers of agonist and antagonist activity.

RESULTS

Four of the products tested, two isoflavone preparations, Promensil and Estro-Logic, chamomile, and grapeseed extracts, were found to have weak estrogenic agonist activity, with the latter two also demonstrating weak progestational activity. Several of the products tested exhibited antagonistic (blocking) activity, including antiestrogenic activity by Prostate-Ease, wild yam root, and dong quai, and antiandrogenic activity by dong quai, Promensil, and rosehips.

CONCLUSIONS

Several of these natural products demonstrate weak steroid hormone activity.

Phytoestrogens and healthy aging: gaps in knowledge. A workshop report

There is an increasing public interest in foods and dietary supplements containing phytoestrogens for the maintenance of health. A workshop was convened to assess evidence for the potential benefits of phytoestrogen-containing foods or supplements on diseases or conditions affecting older populations. Preclinical, clinical, and epidemiologic data on the cardiovascular system, various cancers, bone diseases, and menopausal symptoms were the focus of the discussions. Research on the basis of consumer food choices as well as a presentation from the FDA regarding approval of the use of soy foods to reduce the risk of cardiovascular disease were also presented. Based on the information presented, isoflavone-containing soy foods may have favorable effects on the cardiovascular system, but major knowledge gaps still exist regarding effects ofphytoestrogen supplements on bone diseases, various cancers, menopausal symptoms, and cognitive function.

Dietary inclusion of whole soy foods results in significant reductions in clinical risk factors for osteoporosis and cardiovascular disease in normal postmenopausal women

OBJECTIVE

To determine the effects of dietary inclusion of soy foods on clinical markers for cardiovascular disease (CVD) and osteoporosis in normal postmenopausal women.

DESIGN

This was a single open-group prospective clinical intervention. Forty-two normal postmenopausal women consumed three daily servings for 12 consecutive weeks of whole soy foods containing approximately 60 mg/d of isoflavones. Blood and urine specimens were obtained at baseline and after 12 weeks of dietary intervention.

RESULTS

Serum and urine levels of individual and total isoflavones increased significantly (7-19 fold, p < 0.001) from baseline. A significant increase (9.3%, p < 0.05) in the mean lag-time of low-density lipoprotein cholesterol oxidation was seen and was positively correlated with serum phytoestrogens (p < 0.05). Significant increases were found in mean levels of high-density lipoprotein cholesterol (HDLc) (3.7%, p < 0.05) and serum osteocalcin (10.2%, p < 0.025). Significant decreases were observed in total cholesterol:HDLc ratios (5.5%, p < 0.006) and mean urinary N-telopeptide excretion (13.9%, p < 0.02). Urinary excretion of total isoflavones was negatively correlated with very-low-density lipoprotein cholesterol, triglycerides, and total cholesterol:HDLc ratios (p < 0.04). No significant changes from baseline in HDLc peroxidation, total cholesterol, triglycerides, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, bone-specific alkaline phosphatase, follicle-stimulating hormone, or estradiol levels were observed.

CONCLUSIONS

Dietary inclusion of whole soy foods containing 60 mg/d of isoflavones results in significant serum levels of phytoestrogens and reductions in several key clinical risk factors for CVD and osteoporosis in normal postmenopausal women. Long-term, placebo-controlled clinical trials are needed to evaluate the effect of phytoestrogens on the clinical endpoints of CVD and osteoporosis in this population.

Isoflavonoid compounds from red clover (Trifolium pratense) protect from inflammation and immune suppression induced by UV radiation

Isoflavones derived from many edible plants have been reported to possess significant antioxidant, estrogenic and tyrosine kinase inhibitory activity. Genistein has been found previously to provide protection from oxidative damage induced by UV radiation both in vitro and following dietary administration. We have therefore examined the potential of a number of isoflavones from red clover (Trifolium pratense) and some metabolically related compounds to offer protection from UV irradiation in hairless mice by topical application after UV exposure. We show that whereas the primary isoflavones, daidzein, biochanin A and formononetin, were inactive, 20 microM lotions of genistein and the metabolites equol, isoequol and the related derivative dehydroequol had powerful potential to reduce the inflammatory edema reaction and the suppression of contact hypersensitivity induced by moderate doses of solar-simulated UV radiation. For equol the protection was concentration dependent and 5 microM equol markedly reduced the UV-induced inflammation but abrogated the UV-induced immunosuppression. Equol protected similarly from immunosuppression induced by the putative epidermal mediator, cis-urocanic acid (UCA), indicating a potential mechanism of action involving inactivation of this UV-photoproduct. Since immunosuppression induced by both UV radiation and by cis-UCA appears to be an oxidant-dependent response our observations support the actions of these topically applied isoflavones and their metabolites as antioxidants. They also indicate that lotions containing equol, unlike topical UV sunscreens, more readily protect the immune system from photosuppression than from the inflammation of the sunburn reaction, even when applied after exposure, and thus such compounds may have a future role as sun-protective cosmetic ingredients.

High-protein diets in hyperlipidemia: effect of wheat gluten on serum lipids, uric acid, and renal function

BACKGROUND

The metabolic effects of diets high in vegetable protein have not been assessed despite much recent interest in the effect of soy proteins in reducing serum cholesterol.

OBJECTIVE

We assessed the metabolic effects of diets high in vegetable protein (specifically, wheat gluten) on serum lipids, uric acid concentrations, and renal function.

DESIGN

Twenty hyperlipidemic men and women consumed isoenergetic test (high-protein) and control metabolic diets for 1 mo in a randomized crossover design. In the high-protein diet, 11% of the total dietary energy from starch in the control bread was replaced by vegetable protein (wheat gluten), resulting in 27% of total energy from protein compared with 16% in the control diet. In other respects, the 2 diets were identical.

RESULTS

Compared with the control, the high-protein diet resulted in lower serum concentrations of triacylglycerol (by 19.2 +/- 5.6%; P = 0.003), uric acid (by 12.7 +/- 2.0%; P < 0.001), and creatinine (by 2.5 +/- 1.1%; P = 0.035) and higher serum concentrations of urea (by 42.2 +/- 5.8%; P < 0.001) and a higher 24-h urinary urea output (by 99.2 +/- 17.2%; P < 0.001). No significant differences were detected in total or HDL cholesterol or in the renal clearance of creatinine. LDL oxidation, assessed as the ratio of conjugated dienes to LDL cholesterol in the LDL fraction, was lower with the high-protein diet (by 10.6 +/- 3.6%; P = 0.009).

CONCLUSIONS

High intakes of vegetable protein from gluten may have beneficial effects on cardiovascular disease risk by reducing oxidized LDL, serum triacylglycerol, and uric acid. Further studies are required to assess the longer-term effects on renal function.