Soy Health Effects Evaluating the Science, Overcoming the Misinformation

August 2, 2010

Mark Messina markm@olympus.net

Meat/dairy analogues Soy protein products

Traditional Traditionalsoyfoods soyfoods

Macronutrient (% calories) Content of Beans and Soybeans

Protein Carbohydrate

3 27 70 33
Common beans

Fat

40 27

Mostly oligosaccharides

Grams (g) Protein/(Serving)

Tofu (100 g) 10-15 g Soybeans (85 g), 14 g

Soynuts (28 g) 15 g

Soymilk (250 ml) 68g

Edamame 80 g, 8.5 g

Tempeh 100 g, 18 g

Protein Digestibility Corrected Amino Acid Score of Plant Proteins

PDCAAS = Amino acid requirement X Digestibility

for 1-2 year olds

Limiting amino acid content (mg/g protein)

Soy protein concentrate Kidney beans Rolled oats Lentils Wheat gluten

0.99 0.68 0.57 0.51 0.25

Equal to animal protein

Fatty Acid Profile of Soy Oil from Yellow Soybeans

Independent coronary benefits

6% (3-9)

12% (7-22)

50% (39-53)
J Agric Food Chem 57: 11174, 2009

29% (21-36)
*essential

Oleic (18:1) Saturated

Linoleic (n-6, 18:2)* -Linolenic (n-3, 18:3)*

Search 10/08/09

False or inaccurate Disinformation: information that is deliberately spread

Soy Health Effects Evaluating the Science, Overcoming the Misinformation

Heart disease Isoflavones Cancer Osteoporosis Misconceptions

and safety issues

Product Labels
25 grams of soy protein per day, as part of a diet low in saturated fat and cholesterol, may reduce risk of heart disease

Brazil Malaysia Indonesia Philippines Japan United Kingdom Korea

(JHCI)

Health Claims

Soy, Cholesterol Reduction and Heart Disease Risk

Soy protein
8 metaanalyses

4% in LDLcholesterol
10% in disease risk
Additional reduction (~4%) by substituting soyfoods for higher-saturated-fat, foods

Three-way Protection
1. Direct cholesterol reduction

2. Substition effects
3. Benefits independent

of cholesterol

Circulation 2007;116:2553

The Japan Public Health Center-Based Study Cohort I

Prospective Study

27,435 women Subjects 40-59 years FFQs in 1990 and 1995 12.5 y follow up period 140 strokes 66 heart attacks

Circulation 2007;116:2553

The Japan Public Health Center-Based Study Cohort I

Intake comparison Q5 versus Q1 (1.5 v 0.5 serv/d) Risk*

Stroke Heart attack CVD
*HRs adjusted for age; sex; smoking; ROH, BMI; history of hypertension & diabetes; medication for
hypercholesterolemia; education; sports, intake of F & V, fish, salt, & Kcal & menopausal status . Results SS. Mean isoflavone intakes in Q5 and Q1 = 41 and 11 mg/d, respectively

Circulation 2007;116:2553

The Japan Public Health Center-Based Study Cohort I

Intake comparison Q5 versus Q1 (1.5 v 0.5 serv/d) Risk*

Stroke Heart attack CVD 65% 63%
75%

*HRs adjusted for age; sex; smoking; ROH, BMI; history of hypertension & diabetes; medication for
hypercholesterolemia; education; sports, intake of F & V, fish, salt, & Kcal & menopausal status . Results SS. Mean isoflavone intakes in Q5 and Q1 = 41 and 11 mg/d, respectively

Effects Possibly Contributing to the CHD Risk Reduction Associated with Soyfood Intake

Future Lipid 2007;2:55 AJCN 2008;88:38 EJCN 2003;57:889

LDL particle size LDL oxidation Blood pressure Arterial compliance Endothelial function

Only soyfoods

contain
nutritionally

significant
amounts

Mean daily intake, ~40 mg

~25 mg/serving
250 ml (1 cup) soymilk 100 grams tofu 100 grams edamame 28 grams soynuts
~3.5 mg isoflavones/g protein in traditional soyfoods

Nutr Cancer 55: 1, 2006

OH
7

O1
A
5

C
4

R1

Genistein (50%) Daidzein (40%) Glycitein (10%)

R2

OH

17-Estradiol

Essentially unique to soy

Referred to as phytoestrogens but different from the hormone estrogen

Isoflavones

Preferentially bind to and transactivate ER in comparison to ER

Estrogen receptor- and estrogen receptor- have different tissue distributions and different functions

192,370 cases 40,170 deaths

Is Soy Protective?

Soy prevents breast cancer

Soy causes breast cancer

Is Soy Protective?
Evidence that adult intake is protective is very unimpressive

Soy prevents breast cancer

Early Intake

Toward an understanding of breast cancer etiology

Semin Cancer Biol 8: 255, 1998

BCa risk = # cells at risk # cells at risk early life

Early pregnancy extremely protective
JNCI 2007; 99: 1695

In the WHI cohort, women who had their first child over the age of 30 were 50% > likely to develop breast cancer than women who had their first child before the age of 20

Early Intake

Epidemiologic Research Showing Soy Intake During Childhood and/ or Adolescence Reduces BCa Risk
Author/ Year
Wu, 2008

Location
USA USA

(N) Risk
345 255

Shu, 2001
Korde, 2009 Lee, 2009

Shanghai 3015
Shanghai 305

AJCN 89; 1145 2009; CEBP;10:483, 2001; 18: 1, 2009; AJCN 89:1920, 2009

Epidemiologic Research Showing Soy Intake During Childhood and/ or Adolescence Reduces BCa Risk
Author/ Year
Wu, 2008

Location
USA USA

(N) Risk
345 255 28

Shu, 2001
Korde, 2009 Lee, 2009

Shanghai 3015
Shanghai 305

49
60 43

AJCN 89; 1145 2009; CEBP;10:483, 2001; 18: 1, 2009; AJCN 89:1920, 2009

Young girls should be sure to eat 1 serving per day

Prostate Cancer Incidence Rates in Soy and Non-SoyConsuming Countries

Country USA England Japan Hong Kong China /100,000 101 29.3 9.0 7.9 2.3

Rates, age-adjusted; Int. J. Cancer : 85, 60, 2000

Soy/Isoflavones: Inhibit development

J Nutr 133: 516, 2003; Can Res 68: 2024, 2008; AJCN 2009; J AOAC Int 89:1121, 2006, J Nutr 2009; JNCI 101: 1141, 2009

Prostate Cancer

Inhibit metastases Lower risk among

soy consumers

Slow PSA rise

in PCa patients

 Inhibits bone loss Reduces fractures

Isoflavone Intake and Fracture Risk

Shanghai Womens Health Study 24,403 women Q1 v Q5
Arch Intern Med 2005;165:1890-5.

~1/3 RR Singapore Chinese Health Study

4.5 y follow-up 1770 fractures

Woon-Puay Koh, PhD, National Univ. Singapore; AJE 170: 901, 2009

35,298 women Q1 v Q4 7.1 y follow-up 692 hip fractures ~1/3 RR

Isoflavones and Bone Health

Clinical trials

Supplements Short term Traditional soy Long term

Epidemiologic studies

Soy and Skin Health

(emerging research area)

 Skin lightening Topical Prevent UV damage Application Improve elasticity Prevent hair growth

Does eating soy improve skin health?

Are soyfoods contraindicated for estrogensensitive breast cancer patients?

Soy causes breast cancer

Athymic OVX Mice Implanted with ER+ Breast Cancer Cells (MCF-7)
William G. Helferich, PhD University of Illinois 1997-present

Rodents arent little women

Evidence indicates the tumorstimulatory effects of isoflavones observed in rodents likely dont apply to women

Human
Research

Effects of isoflavones on in vivo markers of breast cancer risk

No effects
Human Reproduction Update

(47)
(8)

Estrogen levels
Tissue density

No effects No effects

Contrast with effects of EPT (hormone therapy)

Cell (5) proliferation

56: 323, 2006

For the breast cancer survivor:

Up to 3 servings/day of traditional soyfoods unlikely to be harmful

The Shanghai Breast Cancer Survival Study

N=5,033 BCa survivors

Intake assessed at 6, 18,
36 & 60 mo post diagnosis

Median follow-up, 3.9 years

During FU; 444 deaths, 534

JAMA. 2009;302:2437

recurrences or BCa-related deaths

The Shanghai Breast Cancer Survival Study

Major findings:

High soy consumers* ~1/3

less likely to die or suffer a recurrence

High soy consumption* was

as beneficial as tamoxifen use

JAMA. 2009;302:2437

*>15.31 g/d soy protein or 62.8 mg/d isoflavones

Options
1. Prohibit soy intake
(current default position)

2. Permit soy intake for those who already use it or want to begin doing so 3. Recommend soy foods for the purpose of improving prognosis

Summary of Clinical Results Related to Soy and Feminization and Fertility

No effects on testosterone (N=36) No effects on estrogen in men (N=9) No effects on sperm/semen (N=3) Very minor effects on female
reproductive hormones (N=47)

May cycle length 1 day (n=10)

The Thyroid Issue

Isoflavones and the Thyroid

Healthy, euthyroid individuals

Subclinical hypothyroidism?
Bitto et al. JCEM,2010

Insufficient iodine intake?

Alekel et al. AJCN, 2009

Complex form of arthritis characterized by sudden, severe attacks of pain, redness and tenderness in joints

Gout
Urate crystal accumulation due to high levels of uric acid in blood

 Does the presence of aglycone

Does fermentation lead to the

Tempe Research Needs

Is mineral absorption superior to

isoflavones affect health effects? that from non-fermented soyfoods? creation of beneficial compounds?

Adult Intake Recommendations

Womens Health (Lond Engl) 2008;4:337.

Based on clinical and epidemiologic studies and principles of sound dietetic practice