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Isoflavones
- 1. Menopause Management Options in the New millenium The Natural, Safe and Proactive Approach
- 2. Mrs. Deshpande Age: 45 Years Mrs. Mistry Age: 52 years
- 3. Mrs. Mukherjee Age: 61 years Mrs. Khan Age: 73 years
- 4. One Link Is Common Between All of Them ……
- 8. Menopause and its implications Long term consequences Menopausal symptoms such as hot flushes Short term consequences Menopause Drastic fall in serum oestrogen levels from 50 – 600 units (picograms per ml) to 5 – 10 units Osteoporosis Risk of CAD Vaginal Atrophy Risk of dementia Oestrogen deficiency
- 10. Total Cholesterol Levels After Menopause Maturitas 12(1990)321-331. Months Percent -24 6 -18 -12 -6 0 Menopause 90 100 110
- 11. LDL Cholesterol Levels After Menopause Percent -24 6 -18 -12 -6 0 Menopause Maturitas 12(1990)321-331. Months 90 100 110
- 12. Triglyceride Levels After Menopause Percent - 24 6 -18 -12 -6 0 Menopause Maturitas 12(1990)321-331 . Months 90 100 110
- 13. HDL Cholesterol Levels After Menopause Percent -24 6 -18 -12 -6 0 Menopause Maturitas 12(1990)321-331. Months 90 100 110
- 14. Most Important Problem of Menopause Osteoporosis Late complaints Silent disease Old age attribution
- 15. Postmenopausal Osteoporosis: What Happens?
- 18. Menopause and Bone Mass Density [BMD] Elder women have 1/2 BMD of that in their 20s Age (yrs) 50 100 ----- Trabecular ----- Compact 30 40 80 Bone Mass density % MENOPAUSE
- 19. Osteoporosis Estimations DEXA (Dual Energy X-ray Absorptiometry) Quantitative computerized tomography Quantitative Ultrasonography T-score indicates the number of standard deviation below or above the average peak bone mass in young adults CONCLUSION - Expensive and not very common
- 22. Options for Menopause Management SERMs HRT TIBOLONE ISOFLAVONES MENOPAUSE
- 23. Hormone Replacement Therapy ERT or HRT = Therapy with either Estrogen alone or combined with a progestin. To strengthen bones To reduce the Risk of heart disease To help control other Menopausal Symptoms such as hot flushes, sweats, disturbed sleep
- 24. Estrogen and Coronary Artery Disease Reduces LDL levels by their action on the liver Increases triglyceride levels Estrogen influences CAD
- 25. Estrogen Effect on Bone remodelling Estrogen effect: bone resorption & bone formation by Direct inhibition of osteoclasts Direct stimulation of osteoblasts Indirect effect by altering local humoral mediators
- 26. Consequences of Hormone Replacement Therapy C onsequence = women may also subject themselves to the harmful effects of estrogen risk of cancer of uterus / breast risk of DVT and Gallstone formation Triglyceride levels. Unusual DUB, headaches, nausea, fluid retention, swollen breasts, weight gain Short term side effects Long term side effects
- 29. Such Drugs Are Available Today PHYTOESTROGENS The Next Frontier In Nutrition
- 31. Hence, phytoestrogens may be described as natural SERMs or natural selective estrogen receptor modulators, since they have both actions – agonistic and antagonistic
- 33. Sources of Phytoestrogens Most food Phytoestrogens isoflavonoids lignans coumestans More than 300 foods have been shown to contain phytoestrogens (Kurzer and Xu, 1997) . found in beans of legume family with soyabeans as major dietary source found in high fiber foods such as cereal brans and flaxseeds various beans such as split peas, long beans, alfalfa and clover sprouts
- 34. Types of phytoestrogens Phytoestrogens Isoflavonoids Lignans Others Isoflavones Coumestans Genistein (~60%) Daidzein (~25%) Glycetein (~15%)
- 36. Isoflavones in Soya Isoflavone R1 R2 Daidzein H H Genistein H OH Glycetein OCH 3 H The principal isoflavones in soya are usually found in the form of glycosides, which after ingestion are hydrolyzed in the large intestine by the action of bacteria to release isoflavones. O O H O R 2 O H R 1
- 37. Isoflavones in Other Foods Formononetin Biochanin A Coumestrol Isoflavones are also found in chickpeas, clover & alfalfa sprouts and are of other types -
- 41. Isoflavones – Selective Estrogen Receptor Modulator Activities Oestrogen Agonist Oestrogen Antagonist Beta receptors - Bone, Liver, Brain Alpha receptors - Breast, Uterus
- 42. MENOPAUSE Short term side Effects like flushing Osteoporosis Decrease in Cardioprotection Alzheimer’s disease estrogen level Isoflavones Isoflavones
- 45. Isoflavones: safety A double-blind placebo-controlled study of 34 premenopausal women found that 1 year's use of isoflavones upto a dose of 100 mg per day had no effect on any of the hormones involved with the menstrual cycle. The effects of an isoflavone intervention on the reproductive cycle of premenopausal women. Presented at: European Conference on Nutrition & Cancer; June 21–24, 2001; Lyon, France.
- 46. Isoflavones: Effects on hormones Results suggest that a soya diet with low levels of isoflavones and low energy intake from protein can reduce circulating ovarian steroids without altering gonadotropins. J Clin Endocrinol Metab 2001 Jul;86(7):3045-52
- 48. Isoflavones: Hot Flushes A double-blind placebo-controlled study was done in 104 women for vasomotor symptoms of menopause Albertazzi P, Pansini F, Bonaccorsi G, et al. The effect of dietary soya supplementation on hot flushes. Obstet Gynecol. 1998;91:6–11 ACOG's position is that short-term (less than 2 years) intake of soy and isoflavones may be helpful in treating vasomotor symptoms
- 50. Isoflavones: + Soya Protein on Total Cholesterol * P<0.05 vs day 0 ISP (+) : soy protein containing isoflavones (33mg) ISP (–) : soy protein deficient in isoflavones (3.2mg) * * lowers total cholesterol by about 9%, Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the effects of soya protein intake on serum lipids. N Engl J Med . 1995;333:276–282.
- 54. Isoflavones: CAD Baillieres Clin Endocrinol Metab 1998 Dec 12:4 589-604 J. Nutr. 125: 624S-630S, 1995 preventing the oxidation of lipoprotein particles preventing cell adhesion altering growth factor activity inhibiting progression of athero-sclerosis Isoflavones prevent CAD by the following proposed mechanisms
- 56. Isoflavones: Blood pressure J Clin Endocrinol Metab 2001 Jul;86(7):3053-60 105 postmenopausal women), received either soya protein isolate (40 g soya protein, 118 mg isoflavones) or casein for 3 months. soya group, as compared with casein, showed a significant fall in BP.
- 57. Isoflavones: Cancer Isoflavone activities on breast and Uterus Induce apoptosis Inhibit differentiation in cancer cells Inhibit cell proliferation Acta Pol Pharm 2000 Mar-Apr 57:2 135-55
- 66. Soya Protein and Isoflavone Content Harv Mens Health Watch 2002 Oct;7(3):1-3 Food Portion Approximate Soya Protein Content (mg) Approximate Isofavone Content (mg) Boiled soyabeans 1 cup 20 47 Soya flour 1/2 cup 25 50 Soya milk 8 oz 4–10 0–50 Soya nuts, roasted 2 table spoons 8 40 Soya sauce 1 table spoon less than 1 less than 1 Texturized soya protein 4 oz 11–16 30–40 Tofu 4 oz 5–13 30–40
- 67. Isoflavones and bone ADMINISTERED ISOFLAVONES Oestrogen receptor on Osteoblast occupied production of interleukins No activation of osteoclasts Resorption is blocked Correction of osteoporosis More bone production than loss and proper mineral deposition occurs
- 68. Isoflavones: Comparison with ERT / HRT Yes Nil Breast pain, tenderness Increased Reduced Risk of endometrial cancer Relieved Relieved Vasomotor symptoms Yes [50 – 80%] Nil Vaginal bleeding Possibly increased Reduced Risk of breast cancer Yes Nil Bloating, weight gain No Yes Action on cholesterol Yes Yes Prevention of osteoporosis ERT / HRT Isoflavones
- 74. Isoflavones - Candidates Premenopausal women as a proactive approach to prevent menopausal complications; Perimenopausal women showing visceral, vasomotor & psychological menopause manifestations Postmenopausal women. Postmenopausal women Perimenopausal women Premenopausal women
- 81. Thank You
Notas del editor
- The accepted definition of osteoporosis.
- Speaker’s Notes There are an estimated 4-6 million postmenopausal women with low bone mass or osteoporosis in the Indian. female population. Based on guesstimates, 54% of the women aged 50-64 are estimated to have low bone mass or osteoporosis (defined by T-score –1.0 SDs or lower). These statistics worsen as women age. Up to 86% of women 65 and over have low bone mass or osteoporosis.
- Speaker’s Notes There are an estimated 4-6 million postmenopausal women with low bone mass or osteoporosis in the Indian. female population. Based on guesstimates, 54% of the women aged 50-64 are estimated to have low bone mass or osteoporosis (defined by T-score –1.0 SDs or lower). These statistics worsen as women age. Up to 86% of women 65 and over have low bone mass or osteoporosis.
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- Speaker’s Notes The National Academy of Sciences Guidelines of 1997 emphasized the need for adequate calcium through diet or supplementation in excess of 1200 mg daily for postmenopausal women. Extra doses of vitamin D are particularly important for the institutionalized elderly. Weight-bearing exercise has been shown to maintain or increase bone mineral density in pre- and postmenopausal women. There are a variety of fall-prevention techniques that are beyond the scope of this presentation.
- Speaker’s Notes The National Academy of Sciences Guidelines of 1997 emphasized the need for adequate calcium through diet or supplementation in excess of 1200 mg daily for postmenopausal women. Extra doses of vitamin D are particularly important for the institutionalized elderly. Weight-bearing exercise has been shown to maintain or increase bone mineral density in pre- and postmenopausal women. There are a variety of fall-prevention techniques that are beyond the scope of this presentation.
- Speaker’s Notes The National Academy of Sciences Guidelines of 1997 emphasized the need for adequate calcium through diet or supplementation in excess of 1200 mg daily for postmenopausal women. Extra doses of vitamin D are particularly important for the institutionalized elderly. Weight-bearing exercise has been shown to maintain or increase bone mineral density in pre- and postmenopausal women. There are a variety of fall-prevention techniques that are beyond the scope of this presentation.
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- Speaker’s Notes There is a hierarchy of research evidence to be evaluated in judging outcomes of any kind. It’s important to make a value judgment based on the individual patient. For example, research dictates that a 62-year-old postmenopausal woman with a BMD T-score of –3.5 should be treated, but if she has terminal breast cancer, clinical judgment advises us to the contrary.
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- The idea that certain foods can be a boon to health is nothing new. Even generations ago, people knew the benefits of eating their vegetables or munching an apple a day to keep the doctor at bay. But in recent years, the food industry has promoted functional foods. Although functional foods remain undefined under current US food regulation, functional foods are generally understood to be foods that provide a specific health benefit above and beyond their inherent nutritional value. Consumers seem to prefer the term functional foods over terms such as nutraceutical or designer foods. Some such foods come naturally packed with healthful compounds, with whole foods such as fruits and vegetables representing the simplest example of a functional food; in other cases manufacturers add certain ingredients to make foods functional, such as cereal with added folic acid. Our supermarkets are full of functional foods, but the increasing number of products claiming specific health benefits is making the grocery store look more and more like a pharmacy. Unlike a drug, though, functional foods are available without a prescription, and often without much guidance on how they should be used. It’s unlikely that anyone drinking calcium-fortified juice will get too much calcium, and we know a lot about how that key ingredient works. But with some of the more questionable products, juices fortified with the herb echinacea, for example, no one yet knows what level of intake is safe or how the substance might interact with other medications. Currently, the Food & Drug Administration and the Federal Trade Commission is responsible for regulating functional foods.
- The idea that certain foods can be a boon to health is nothing new. Even generations ago, people knew the benefits of eating their vegetables or munching an apple a day to keep the doctor at bay. But in recent years, the food industry has promoted functional foods. Although functional foods remain undefined under current US food regulation, functional foods are generally understood to be foods that provide a specific health benefit above and beyond their inherent nutritional value. Consumers seem to prefer the term functional foods over terms such as nutraceutical or designer foods. Some such foods come naturally packed with healthful compounds, with whole foods such as fruits and vegetables representing the simplest example of a functional food; in other cases manufacturers add certain ingredients to make foods functional, such as cereal with added folic acid. Our supermarkets are full of functional foods, but the increasing number of products claiming specific health benefits is making the grocery store look more and more like a pharmacy. Unlike a drug, though, functional foods are available without a prescription, and often without much guidance on how they should be used. It’s unlikely that anyone drinking calcium-fortified juice will get too much calcium, and we know a lot about how that key ingredient works. But with some of the more questionable products, juices fortified with the herb echinacea, for example, no one yet knows what level of intake is safe or how the substance might interact with other medications. Currently, the Food & Drug Administration and the Federal Trade Commission is responsible for regulating functional foods.
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- Speaker’s Notes Benefits of raloxifene include improved bone mass, no breast tenderness, bleeding, or spotting and the potential for reduced risk of breast cancer. Raloxifene does not relieve vasomotor symptoms: Hot flashes are often the reason patients come in for treatment. Raloxifene may increase hot flashes. Decreases low-density lipoproteins but does not increase high-density lipoproteins.
- Soybeans and other legumes are best known as an excellent source of protein. They are also rich in calcium, iron, zinc, vitamin E, several of the B-vitamins and fiber. They are low in saturated fat, but rich in omega-3 fatty acids. 25 grams of soy protein per day may reduce the risk of heart disease. The phytoestrogens or isoflavones may reduce menopause symptoms such as hot flashes. Saponins may lower LDL cholesterol and contain anti-cancer enzymes. Tofu takes up the flavor of what it’s cooked with, but many individuals are opposed to its mouth feel. Try grinding up a third of a package of tofu to add to any combination dish. You’ll add high quality protein, more calcium if it’s fermented using calcium, reduce the fat content of the dish AND give you the added of disease fighting phytonutrients.
- Soybeans and other legumes are best known as an excellent source of protein. They are also rich in calcium, iron, zinc, vitamin E, several of the B-vitamins and fiber. They are low in saturated fat, but rich in omega-3 fatty acids. 25 grams of soy protein per day may reduce the risk of heart disease. The phytoestrogens or isoflavones may reduce menopause symptoms such as hot flashes. Saponins may lower LDL cholesterol and contain anti-cancer enzymes. Tofu takes up the flavor of what it’s cooked with, but many individuals are opposed to its mouth feel. Try grinding up a third of a package of tofu to add to any combination dish. You’ll add high quality protein, more calcium if it’s fermented using calcium, reduce the fat content of the dish AND give you the added of disease fighting phytonutrients.
- Soybeans and other legumes are best known as an excellent source of protein. They are also rich in calcium, iron, zinc, vitamin E, several of the B-vitamins and fiber. They are low in saturated fat, but rich in omega-3 fatty acids. 25 grams of soy protein per day may reduce the risk of heart disease. The phytoestrogens or isoflavones may reduce menopause symptoms such as hot flashes. Saponins may lower LDL cholesterol and contain anti-cancer enzymes. Tofu takes up the flavor of what it’s cooked with, but many individuals are opposed to its mouth feel. Try grinding up a third of a package of tofu to add to any combination dish. You’ll add high quality protein, more calcium if it’s fermented using calcium, reduce the fat content of the dish AND give you the added of disease fighting phytonutrients.
- Soybeans and other legumes are best known as an excellent source of protein. They are also rich in calcium, iron, zinc, vitamin E, several of the B-vitamins and fiber. They are low in saturated fat, but rich in omega-3 fatty acids. 25 grams of soy protein per day may reduce the risk of heart disease. The phytoestrogens or isoflavones may reduce menopause symptoms such as hot flashes. Saponins may lower LDL cholesterol and contain anti-cancer enzymes. Tofu takes up the flavor of what it’s cooked with, but many individuals are opposed to its mouth feel. Try grinding up a third of a package of tofu to add to any combination dish. You’ll add high quality protein, more calcium if it’s fermented using calcium, reduce the fat content of the dish AND give you the added of disease fighting phytonutrients.