Search results for isoflavones

Wednesday Bubble: Black cohosh – is it safe?

Posted by Liz on Jun 22, 2011 in herbal medicine | 2 comments

Back in 2009, I wrote a post regarding black cohosh (better known in scientific circles as Cimicifuga racemosa) and potential safety issues, namely harm to the liver. In it, I discussed a small case review that showed no link between ingestion of black cohosh and liver toxicity. And yet, in 2006 the European Medicines Agency and the Committee on Herbal Medicinal Products released a public statement alerting health authorities to 42 suspected liver reactions among women taking black cohosh. In the very same report, they noted how inadequately adverse reactions were documented. Indeed, only 16 of the cases were considered to have sufficient data to allow for proper assessment of a potential link, and of these, only four showed any sort of association, albeit, unproven. Regardless,  the statement resulted in Italian health authorities requesting a precautionary withdrawal of black cohosh preparations from the market, and UK authorities issuing strict label requirements and warnings.

Hence, I was intrigued when I ran across a detailed review of black cohosh safety, both from perspective of over 107 patient cases and of published study findings. Following is the lowdown:

• An Italian clinic regularly prescribed 500 mg or 1000 mg daily black cohosh, either alone or in combination with other herbs (e.g. soy isoflavones, red clover or alfalfa) for treatment of menopause symptoms and disorders (e.g. anxiety, depression, hot flashes and joint pain). None of these herbs were prescribed to women with previous cancer of the breast, ovaries, uterus or pituitary gland. Moreover, the researchers say that they had not received any reports of any sort of adverse event.
• Still, following the European health statement, they contacted 107 women in good health and in different phases of menopause, took blood samples, underwent clinical examination and participated in phone interviews to evaluate if they were still taking the herbs. Of these women, only five had chronic but benign liver disease and one, hepatitis.

The findings? Despite the four patients suffering from prior benign liver disease, there was no additional sign of liver problems nor altered laboratories indicating a worsening condition or a new condition. Nor were there any clinical signs of liver damage after a year of using high dosages of black cohosh.

The researchers who reviewed and examined patients as well as the published literature point out that the liver is central to metabolizing most drugs and hence, there is a potential for an adverse liver event from taking nearly every medication that involves liver metabolism. They note that a step-by-step examination is also necessary to rule out other causes of liver damage, including infection, alcohol use and related conditions. In so far as herbs go, they write that “it is very important before an official statement about any adverse reaction referred to an herb based product to know the brand, dose of substance assumed, type of extract [and] content of possible contaminants.” They go on to state that it is their opinion the statement could actually be used as proof that black cohosh liver toxicity is scarce because despite over a million doses used worldwide annually, there is not any fully proven case of liver toxicity. Moreover, they claim that black cohosh safety has already been established in over 3,800 participants in clinical trials.  Their conclusion? black cohosh should be considered safe, at least in so far as liver toxicity goes.

What should you do?

If you wish to try black cohosh, speak to a licensed practitioner well versed in herbal medicines. Look for a standardized form to insure that the pills contain what they say they do. And if you start feeling poorly while taking black cohosh? Stop immediately and contact the person responsible for your care.

Black cohosh and liver toxicity. This one appears to be a bubble bursting worthy.

Cocoa loco? The lowdown on chocolate and heart disease

Posted by Liz on Jun 17, 2011 in heart disease | 0 comments

[youtube=http://www.youtube.com/watch?v=RZ-uV72pQKI]

If you are a chocoholic, I bet you’ve noticed the headlines linking chocolate to a reduced risk of heart disease. In fact, data from the Kuna Indians (a tribe indigenous to Panama) have shown that cocoa and in particular dark chocolate are associated with declines in blood pressure. More recently, a large government study showed an even greater benefit in terms of a significant reduction in coronary heart disease prevalence. And in women, who have an increased risk for heart disease as they age (not only due to the increase in abdominal fat or changes in their blood fat levels but also to loss of ovarian function), chocolate has ben shown to slightly lower the risk of dying from heart disease.

Sounds promising and quite frankly, awesome, right?

Well…before you run out to the grocery or chocolate shop, you may want to read further…

Researchers have long been interested in flavonoids and in particular (at least in so far as menopause goes) in isoflavones. (See soy posts for more on isoflavones). The specific compound or molecule of interest in cocoa (the non-fat component cocoa bean extract or liquor) are flavanols, which are also found in lower concentration in apricots, peaches, apples, green and black tea, red wine and cider). Note that the quantity of flavanols in chocolate depends on manufacturing, including fermentation and roasting, and how much treatment is given to reducing bitterness and improving consistency. What this means is that dark chocolate has the highest concentration of flavanols and milk, the lowest.

What have researchers learned so far?

• Flavanols found in cocoa and cocoa powder may be powerful antioxidants and as such, help to mitigate certain factors that contribute to atherosclerosis, such as the formation of plaques in the arteries that lead to stroke and other coronary events. Thus, as antioxidants, they may actually neutralize toxic oxygen species circulating in the bloodstream.
• Experimental data suggest that ingestion of flavanols may help to regulate proteins and other compounds that encourage an inflammatory response to leads to heart disease.
• Flavanols may also help to stabilize the lining and muscular tone of the arteries and prevent them from narrowing.
• Additionally, flavanols may moderately protect against high blood pressures, although studies have been mixed.
• Finally, flavanols may help to maintain blood sugar levels and improve the ratio of good to bad fats in the blood.

Wow, this sounds fantastic! And all it takes is a daily diet of dark chocolate?

Here’s the great news. Researchers are devoting increasing amounts of time toward learning how certain foods affect (and benefit) health. However, in so far as chocolate goes? In a thorough review published online in Maturitas, they write that of the studies that have been conducted, it’s truly difficult to determine whether or not there is a causal relationship, i.e. eating A causes B, or eating chocolate prevents heart disease. In the case of chocolate in particular, factors like manufacturing can influence study findings. Moreover, researchers still aren’t sure if they should be focusing on flavanols or some other component of cocoa. It is also possible that only people who already have some sort of problem or condition will benefit  from eating more chocolate.

The bottom line? Dark chocolate in moderation, won’t hurt you and may actually help you. However, you may want to temper expectations. At least a wee bit. Dare to dream though…perhaps cocoa will ultimately defy explanation!

More on soy? Oh joy!!

Posted by Liz on Apr 15, 2011 in hot flash, nightsweats | 2 comments

A close friend of mine wrote me the other day to tell me about an article she had seen. In it, the author claims that using soy sauce will help to alleviate hot flashes. However, the author neither backs this claim with any evidence or provides information on how much soy sauce you’d need to obtain the minimal level typically associated with some sort of reduction in menopausal symptoms.

Because there’s a ton of bad information floating around the interwebz, I wanted to break it down for you, right here and now. I also encourage you to peruse the archives because I’ve written a ton of posts on soy isoflavones.

Here’s what we know thus far about soy and soy isoflavones:

• Soy isoflavones are plant-based compounds that are believed to mimic the action of natural estrogen in the body. Therefore, researchers have been dissecting and studying the properties of soy for years in order to determine if this alternative to hormone replacement can help alleviate hot flashes and night sweats, and possibly even promote bone health in menopausal women.
• The deeper researchers delve into the properties of soy, the more they are learning. For example, the ratio of the most plentiful soy isoflavones, i.e. daidzein and gensistein, are important, and a metabolite of daidzein called S-equol appears to be the most potent in terms of preventing flashes and sweats.  S-equol  is produced in the gastrointestinal tract however the ability to actually manufacture it depends on the presence of certain microflora. Consequently, only 30% to 60% of individuals are actually able to produce S-equol on their own (although this figure is believed to be higher among Asians and vegetarians).
• Studies that have examined the role of a soy-based diet, mostly among Asian populations, typically focus on four main foods that are rich sources of soy isoflavones: tofu, miso (fermented soybean paste), natto (sticky, fermented soy food rich in vegetable protein) and fried tofu. Soy sauce and soy oil do not contain isoflavones! Therefore, using either in cooking will not prevent hot flashes or night sweats.
• In a more recent review of soy products published in the American Journal of Epidemiology, researchers evaluated the dietary habits of 1,106 Japanese women between the ages of 35 and 64 over six years to determine a possible association with hot flashes or lack thereof. All participants were asked to record what they were eating as well as the serving size; included were nine specific soy products (miso soup, tofu, deep-fried tofu, fried bean curd, dried bean curd, natto, houba miso, soy milk and boiled soybeans).

The findings? There was an inverse association between eating soy and hot flashes – those women eating the greatest amount of soy, i.e. 115.9 grams/day, that contained the greatest amount of isoflavones, i.e. 50.8 grams/day, had the highest amount of protection against developing hot flashes and a 6% lower risk than women who consumed the least amount for developing hot flashes over the course of the study. Moreover, the results were upheld even after researchers accounted for factors such as age, menopausal status and total daily caloric intake. Notably, if soy sauce or oil actually contained isoflavones, an individual would have to consume at least 4 ounces of soy sauce daily to obtain any benefit.

Most importantly, when it comes to soy, even supplements aren’t created equal. If you are going to go that route, speak to a licensed practitioner who specializes in herbal medicine and look for a supplement that notes standardized manufacturing on its label. Simply walking into a drugstore to make a purchase is a sure way to guarantee that skimping on price often means skimping on quality.

There’s a lot more we need to learn about soy before making blanket recommendations. Soy is more complex than researchers originally thought. And a few drops a day? No way!

Are you getting the sleep you need?

Posted by Liz on Feb 14, 2011 in sleep disturbance | 4 comments

Sleep.

Sometimes I don’t even know what that means any longer. I long for the day (night) that I sleep a solid eight hours without awakening. However, that may the thing that my dreams are made of.

As I’ve written previously on Flashfree, sleep becomes more of an issue as we grow older.  Factors like less efficient sleep and a greater difficulty staying asleep can lead to depression and affect overall wellbeing. More frustrating than  the lack of sleep however, is the fact that experts can’t quite agree on the key factor underlying sleep disruptions: is it aging? Hormone fluctuations? Apnea? Moreover, do you treat the cause or the factor?

Besides my own personal interest in the topic, I do believe that the more that individuals understand the factors affecting their sleep quality, the greater their ability to proactively do something about it. That’s why I am always intrigued when I run across new research, like this study on isoflavones and sleep in the February edition of Menopause.

In it, 38 menopausal women who qualified as insomniacs (i.e. having difficulty falling or staying asleep or whose sleep is disrupted or insufficient enough to affect alertness and physical/mental wellbeing) participated. Over a course of four months, the women were asked to take a daily 80 mg isoflavone pill (primarily made up of genistein) or a sugar pill. During the study, all women had blood work done, were visited monthly by a researcher to discuss their menopausal symptoms/complaints, and underwent sleep assessments.

The researchers say that they found that use of daily isoflavones actually decreased the frequency of insomnia by as much as 30%, and increased sleep efficiency — the ratio of time asleep to time spent in bed — by as much as 6%. Apparently, women using isoflavones also had fewer and less intense hot flashes.

Importantly, the researchers say that there is a paucity of published sleep studies in menopausal women and even fewer that look at alternative or complementary therapies. Nevertheless they point out that by using a standard of sleep analysis — polysomnography – they were able to demonstrate significant objective improvements in insomnia among women taking isoflavones. In contrast, studies reporting improvements in sleep after hormone therapy have been based on subjective reports.

Another critical point that they make is that although this was a small study, almost 70% of women had objectively defined insomnia, demonstrating the breadth of the problem in menopause. Moreover, sleep disturbances that drove these women to seek help tended to be individualized, indicating that there is a depth of insomnia-related complaints that affect aging women in this stage of their lives that warrant a closer look.  Still, despite these differences, soy appeared to work well across the range of complaints.

Are closer to unlocking the chicken versus egg, ie aging versus factors mystery surrounding sleep? Perhaps not. And it’s unlikely that soy will work exactly the same for each person. No medicine does. However, soy appears to be a safe and potentially effective treatment for sleep disturbances during menopause.

How’s your sleep? And what steps are you taking to improve it? `

Wednesday Bubble: hot flashes and antidepressants

Posted by Liz on Jan 19, 2011 in hot flash | 4 comments

Researchers have been studying antidepressant therapy (namely selective serotonin reuptake inhibitors – SSRIs, and serotonin/norepinephrine reuptake inhibitors –SNRIs) for some time now in hopes of discovering an effective treatment for hot flashes and an alternative to hormone replacement therapy (HRT). However, antidepressants’ ability to ameliorate hot flashes have yielded mixed results in the study arena. One potential advantage of using an antidepressant in this regard is the ability to also effectively address mood swings and depression that occur as hormone levels wane and decline throughout menopause. Hence, I was intrigued by a new study, published this week in the Journal of the American Medical Association, that not only evaluated the benefit of using the SSRI Lexapro for hot flashes but also, whether or not factors such as race and coexisting depressed mood and/or anxiety would affect the results. Notably, African-American women are reportedly more likely than report having particularly bothersome hot flashes.

In this particular trial, 205 menopausal or postmenopausal women reporting at least 28 hot flashes or night sweats per week over a three week period that were bothersome or severe the majority of time were asked to take 10 mg escitalopram (Lexapro) or placebo tablet daily for 8 weeks. This dosage was increased midway through the trial if hot flash frequency didn’t decrease by at least 50% and if severity did not change.

The findings:

• More than half of women reported that the frequency of their hot flashes declined by at least 50% from the study starts (compared to slightly more than a third of women taking placebo)
• Women taking Lexapro reported that the severity of their hot flashes decreased by 24% compared to the study’s start (and a 14% decline in severity among the placebo group)
• The response to Lexapro was rapid and improvements started to be seen within one week
• Reported side effects between the two groups were fairly equal, and mostly related to feeling tired, stomach issues and dry mouth
• Race did not appear to play a role in either group
• Hot flashes returned after Lexapro was stopped

Although the researchers caution that the group of women in the study were highly motivated and not necessarily reflective of women in the general population, I would argue that a woman with severe and frequent hot flashes is motivated, period. I’m not a huge fan of using pharmaceutical medications to address menopausal symptoms for two reasons: 1) menopause is not a disease and, 2) as evidenced by the archives, there is an evolving body of literature that supports the use of alternative strategies for managing menopause. Nevertheless, as someone who has had lifelong bouts of depression that are exacerbated by hormones, I welcome an effective alternative to HRT that might be more broadly embraced by the medical community. Until a greater proportion of healthcare practitioners begins to accept the distinctions between between eastern and western medical philosophies and the potential advantages of complementary strategies, the learning (and begging) curve will continue to be steep.

Perhaps antidepressants are an initial stop-gap while the body of evidence supporting alternatives like acupuncture or isoflavones for hot flashes and depression grows. I’m optimistic we’ll get there. And I will always be happy to see women provided with an alternative to HRT.