{George’s Note: I have not edited this program in any way. I make no claims as to the authorship of this transcript or the information contained within, all information belongs to Body Rx Radio and I make no guarantees about the information you will find here, I have transcribed this for information purposes only. With that in mind, enjoy! I sure did.}

body rx radio show transcripts

Body Rx Show Transcripts: #12 Protein And Skeletal Muscle’s Effects On Bone Density

{The original mp3 file can be found on this page Body Rx Radio Archives. Direct mp3 link Body Rx Radio Epidsode 12.

Carl: Hey, welcome back to BODYRX with Dr. Scott Connelly; myself, Carl Lanore and Vince Andrews.  How are you doing Dr. C?

Dr. Connelly: Great Carl. How are you today?

Carl: I am wonderful. How about you Vince?

Vince: I am awesome. Thanks Carl.

Carl: Yes, I have heard that actually that you are awesome.

Vince: Yeah! Having a good day, having a good day.

Carl: So Dr. C before we start the show, I just wanted to mention to the listeners that Dr. Paul Arciero emailed us something last week after the show that we did, talking about the relationship between the bone and muscle, something that you had discussed and in theory and he found a study that just came out a month ago that proves that your opinion was correct. Did you see that study on the role of myokin and muscle-bone interactions?

Dr. Connelly: Yes I did. That was essentially one of the most recent demonstrations that several aspects of the intracellular processing of nutrient messages relating to muscle mass maintenance and growth are essentially replicated in bone cells especially with respect to the effect of enhancing bone anabolism or bone growth, and that has been one of the areas of research that myself and my colleagues in Australia have been focused on for some time. I was looking at fractions of way protein derivatives that have these properties of being able to insinuate their effects rather proximally or directly into messaging that goes directly to the nucleus of the cell and impacts gene production that goes out into the cytoplasm and directs very specific cellular synthetic pathway activities, and obviously in the perspective of what is the most optimal strategy for protein supplementation key components of intracellular signalling that affect primarily synthesis would be expected to have a very positive effect on the problems posed by decline in bone integrity with age or the osteoporotic pathology. Some of these fractions that we have studied in particular are related to but not exactly concordant with the compound that I mentioned on the last show and that was the bovine angiogenin. That is a relatively interesting compound that from a chemical standpoint is what we call a ribonuclease and it sort of is lumped into the basket of a collection of molecules that have varying similar molecular attributes that all have been shown to have very, very significant and multidimensional effects on cell growth, differentiation, repair and functionality, and with respect to the bone cell as we know the loss of the intramedullary portion of bone which is really the architectural anchor of the bone and not the actual surface or cortical bone is very sensitive to the balance between overall bone anabolism or the synthesis of new bone  and the resorption of bone, and one of the issues that is clear from a lot of the drug research and so forth is that a rather one-dimensional perspective has been developed by institutional medicine and with respect to the pharmacology of this process in developing drugs which primarily and almost singularly affect the inhibition of bone resorption of the retardation or slowing of bone resorption. This is the classic mechanism of action of what are called the bisphosphonates that have achieved very significant market penetration in the osteoporosis pharmacological theatre.

Carl: Is that the one that Sally fills, whatever the name is that promotes for one of the companies out there?

Dr. Connelly: Well, Seeing Sally filled on any visual image renders me apoplexic and so it just ___ whether or not she is on an alendronate-type commercial or not but I suspect it is a bisphosphonate that she has stamping for.  These bisphosphonate are not innocuous. They have significant toxicity with not infrequent very problematic side effects for patients and they are sort of universal prescription for this problem. Again, in the face of mounting evidence that  this is as much an activity and nutrition-related pathology as it is anything with emphasis on the combined influence of activity or mechanical loading of the skeleton in addition to the nutritional intake of humans, you know figures prominently in this, and that was really kind of one of the discussion points of the last show was is there a point to making a general prescription for protein enhancement in a diet and does it affect favourably these in disease of bone strength and mass and can we show from a standpoint of any kind of reasonable existing data whether that kind of supplementation over usual and customary-kind RDA type of prescription has an effect on really the endpoint that makes the most difference to a position, and that is fractures, and we had discussed the fact that prior to the recent publication of the Framingham osteoporosis study data, there were lots of mixed data, mostly positive on the effects of overall dietary protein enrichment on the general parameters of bone mineral density and things like that, but what was really lacking was some kind of a prospective trial that looked at the ultimate effect on the incidence of fractures and the Framingham Osteoporosis Study finally provided a rather unambiguous answer to that. It was sort of a followup to a similar study __ Boston design that was done in Iowa a few years ago, but nonetheless the concordance of the data in my view really substantiates an overall, generally comfortable recommendation from physicians to their patients especially as they mature through the years to be careful to elevate your dietary protein intake above the levels of the RDA and my recommendations from the standpoint of the RDA are meaningless because I do not understand why the RDA is still used. Is there any kind of a yardstick for measuring protein optimization since it really is derived from metrics of growing animals in which the confusion of the enhanced deficiency of protein deposition with the high levels of circulating somatic hormones like the androgens, estrogens, thyroid, growth hormone and so forth obviously skew the development of tissues to a growth program by virtue of the non-nutritive aspects of amino acid supply and somatotropic hormone influences, but nonetheless if an elderly person were to benefit from this strategy, they would be looking at intakes roughly of anywhere from 1.2 to 1.5 grams per kilogram per day as opposed to the RDA of 0.8. That for an elderly person is a stretch because one to the problems with elderly nutrition is a general loss of appetite and a sort of refractory state of responsiveness with respect to the key elements of the diet that is the essential amino acid mixtures that are known to propagate signalling through the regulatory molecules. There is a  defined refractory state that occurs with aging in humans that makes it even more important to not only be aware of the total quantity but also the quality of the intake with respect to eating protein sources that are particularly enriched in branched amino acids and a high content of those constituents and meat, poultry, eggs, fish and so forth is obvious, but unfortunately those are the kinds of things that require ingestion of fiber _____ at each sitting and with the diminished appetite of the elderly it is difficult to achieve the threshold levels of intake that would be required to bring about these beneficial effects on the bone mass density and enhanced fracture rate, and therefore again issue of judicious supplementation regimen is paramount in this framework especially with the elderly where modest ingestion of highly concentrated sources of protein enriched with the amino acids is quite beneficial, and I guess over the past several shows we have discussed what the optimum delivery package for that would be and we obviously focused on the two most widely available sources of protein supplements in the Western market today and those are dairy sources and soy protein sources. We kind of concluded our examination of the issue of bone growth on soy. Last week discussion of a recently published article in which they actually looked at enriching in a prospective way the diets of postmenopausal women with known quantities of isoflavones in an elaborate design that control for a lot of different factors that would normally be confounding in such a human-based study. And one of the intriguing ones was the issue of what is known as an equol responsive state versus a non-equol responsive state which they in fact controlled for and showed no difference between the two. And since last week I have done a couple of sort of recurring questions from listeners about that issue because it is not one that is well known. So I thought perhaps for the next couple of minutes I would review that just to make sure that people are aware of what the equol issue is and what it is all about and then we can take out first break and go on to discussing some more aspects of soy, non-amino acid  considerations in soy as I relate to a couple of very important areas that  have emerged in the market place as preeminent drivers of sale and those would be the estrogen-related effects of these Phytosterol-type compound in particular the issue of control of menopausal symptoms and the issue of the intersection of breast cancer risks, recurrence and soy ingestion. But to clear up the equol consideration, equol is a derivative, a metabolic derivative, of the primary phytoestrogen daidzein, and what is interesting is that one of the profound difference is that accrues in animals versus humans with respect to phytoestrogen intake and the ensuing biological effects is related to equol, and the reason for that is this – Soy is a very prominent source of two particular compounds, genistein and daidzein, and those compounds are active only in a form that is called the unconjugated form. The dietary ingestion of these compounds occurs in their natural form as conjugates or combinations of these actives with usually a carbohydrate moiety as a carrier. Upon ingestion, these enter the bloodstream readily. They gain access to the systemic circulation quickly and are distributed to the body but there is actually a very low percentage on the first pass through the body of active compound because they remain in a conjugated form. These compounds then undergo a process that is known as enterohepatic circulation. They can actually be processed in the liver and redelivered back to the intestinal tract through secretory mechanisms where upon these conjugates are acted upon by intestinal bacteria and it turns out that a very particular species of bacterial resident in the human colon is capable of converting these conjugates to their unconjugated or aglycone form which then could be reabsorbed as active compounds and it is these active, unconjugated aglycone forms that do the trick. Now, one of these compounds that is produced in this microbial transformation is this compound equol and equol is interesting because it in particular has demonstrable potency far and above either the other two commonly discussed compounds, with respect to estrogen receptor activity and in fact its effects on estrogen beta receptors is several orders of magnitude higher than its parent compound, daidzein. Part of the explanation of why animal studies show more consistently effects of these compounds on one tissue or one reaction sequence or another is probably related to the fact that most of the animal species used in these studies, particularly rodents and in some cases nonhuman primates, in those animals, conversion to equol is what we call constitutive that is it occurs in 100% of the animals because the resident bacterial microflora in those animals is capable of making this conversion easily. That is not the case in humans and in fact in various estimates, only 30 to 50% of humans directly assessed for this capability are able to produce equol. Because of the striking differences in equol’s potency biologically, it has been hypothesized that equol and not a particular isoflavones commonly identified genistein or daidzein is in fact what does the magic. So one of the issues that has recently been addressed is looking at the some of the “effects of isoflavones” on various parameters that we have discussed, lipoproteins etc, etc and kind of saying,”Well maybe the confusion is related to only half of the population of humans is actually producing the active ingredient and so recently there was a publication, just in the last month, in which a Japanese group took that step and looked at the administration of a natural equol as an cantemir. It has a kind of a right and left mirror image thing. So they used the bioactive S-equol as a supplement and hit the level of 10 milligrams daily in women who they have predetermined were not equol producing females and then they looked at bone mineral density and bone resorption as measured in a collection of urine which are typically ascribed as breakdown products of bone. What that study found was that there was a difference with respect to the elaboration of these breakdown products collected in urine; hence, they announced, “Aha! See, these things do in fact diminish bone resorption,” but when they did the _ of the actual study of bone mineral density especially in the areas that are commonly at risk for fracture risk spine and femoral neck, there were no differences between the groups. So it is of some interest that they were able to show with a purified version of S-equol that they could look and find definitive decrease in the excretion of biochemical markers that are typically believed to reflect bone resorption, but again in the end, the real meat of the result of the bone mineral density changes were not observed, but that is a consideration that is probably relevant in all of these studies, and that is how much of the soy effect is in fact related to Equol. It has been shown that there is an ethnic difference with respect to equol producers especially in females, ageing females, having habitually high intakes of these are more likely to be equol producers than Caucasian woman who have drastically reduced levels of consumption of these products. But again overall the literature on this in terms of bone clinical effects and that was reflected in the study we discussed last week. It was entirely confusing or negative or all of the above. So in essence, our distinction last week that for the purposes of you know a real result the data that looks at the constellation of milk derived factors that not only bone anabolism through a direct effect on OPG_ and very substantial effect plus the antiresorptive capabilities of bovine and _____ probably would argue strongly for supplementation with dairy with respect to bone. That being said, it is probably time for a little music break and when we come back, another clarification about a question from last week and then we are going on to some other stuff.

[Music Interlude]

Carl: Welcome back to BODYRX and Dr. Connelly, do you want to pick it up from where you left? You had some questions coming from a listener.

Dr. Connelly: Yeah! Again from last week we have talked about protein supplementation in general and the effects of dietary protein overall on bone anabolism and breakdown and we talked very briefly about an issue that some people found confusing and other people understand and make a big deal about and that is the acid-base balance of the body and how it affects bone balance. One of the issues that prompted people earlier on to sort of recommend a switch from animal-based proteins to more plant-based proteins particularly soy was the notion that animal proteins, because they contain large numbers of sulfur-containing amino acid residues, that these kinds of animal protein contribute to a problem that is essentially epidemic in all western diets and that is the dislocation of the contribution of hydrogen ions to the blood stream versus bicarbonate ions to the bloodstream. These are the effects of diet and this has to do with the following – We have talked many times in reference to looking at aspects of ancestral intake and made it clear that ancestral diets do not reflect an overall uniform distribution of macronutrient because obviously in human evolution, humans were developing in all areas of the planet at all latitudes consistent with survival and in terms of environmental temperature extremes and thus some 50 thousand years ago, there are humans exhibiting or living and thriving in circumpolar regions where plant life was drastically different in abundance than groups developing near the equator. So when you say, “What is the ancestral diet?” The answer is, “Oh, there is not any ancestral diet.” What you can say is what the attributes of the diets were in terms of having things in common and things that they did not have that are now plentiful and that has really been the crooks of a lot of the researcher arguments that looked toward modifying western diets to make them more align with what was prototypical for the vast majority of the early humans and one of the issues that has repeatedly been emphasized and rightly so is the inversion of the intake of potassium and sodium. The “prototypical” diet of early humans was particularly enriched in potassium salts usually from the vegetable sources of food stuffs that they have available in their natural environment. The most abundant of those were probably things like potassium citrate, but nonetheless they had a dietary intake of carbohydrate that delivered ample amounts of bicarbonate-producing mild organic salts, and in essence this provision of dietary-induced bicarbonate into the plasma compartment where the acid-base status of the body is the closest to be regulated, diminished or offset the provision of hydrogen ions from mild organic acids or whatever their source. Meat and cereal grains in particular are the main offenders in the western diets with respect to the provision of mild organic acids and it has been demonstrated that the overwhelming consumption of these kinds of products, particularly now cereal, refined cereal grains with the diminution in the absolute intake of fruits and vegetables and the consequent loss of dietary intake of potassium has unbalanced the delivery of acid-producing hydrogen ions and on neutralizing bicarbonate ions. Because the system will tolerate minor excursions in this kind of a balanced seesaw, it is possible to sustain the physiologic state in a condition that is known as a mild hyperchloremic metabolic acidosis and that simply means that the metabolic acidosis is not significant enough to derail physiologically regulated processes that are dependent on normal ph values but nonetheless there is a slight skewing towards the acid side of the balance point, and because any further excursion from that mild acidotic endpoint is not tolerated, there is a closely monitored provision of existing assault to normalize this to actually make up for the lack of dietary-derived bicarbonate production and hence things like calcium salts, magnesium, potassium phosphorous are contributed from existing tissue stores and guess where most of those lie. Well, most of them are in the bone. So over the course of many years, this net metabolic acid excess is thought to have a quantitative effect on bone mass. Now when you look at this process acutely and in short-term studies, the overall effect of the net acid load and all of its various downstream effects enhanced excretion of calcium etc, etc, etc is very minor. In fact, if you were not looking for it, it would be hard to find it, but nonetheless it does not negate the possibility that over time this persistent acid state will be at mild can contribute to progressive bone thinning, and in fact there is evidence to support that from natural experience of the circumpolar early humans, the early contact anthropologist and so forth and suggestion that met up with these people at some point in time and discovered that they were healthy but osteoporotic. So the net acid load can in fact be seen to affect human beings over their life span and thus it is reasonable to suggest that this provision of potassium-rich food stuffs in the form of vegetables and fruits mainly are an important consideration in osteoporosis. But as I said and as the study that Carl mentioned at the start of the program reiterated, perhaps a much more important emphasis on maintaining bone integrity as the realization that the integrity of the skeletal muscle system is just as important in that loading of bone through muscular activity particularly resistance-type exercises of high intensity but brief duration, the kinds of things that early humans would have experienced in their normal day to day lives has a very prominent and powerful effect on bones. So in essence one of the attributes that has led to the discussion about in a soy bean preferable again refers to this provision of alkalinizing material as opposed to acidifying material and although that is a valid argument, the obvious _ area as well a meat diet is obviously not associated with adverse effects in the presence of vegetable carbohydrate consumption so we are back to square one where we are looking at again the optimal intake is one in which the potassium and sodium ratio is not inverted and that meat is not harmful because it is consumed in the context of adequate base-producing foods in the form of low glycemic index vegetables and fruits. So the issue for acid-base and bone has largely been resolved to reflect the inadequate consumption of plant-based producing materials and the over consumption of cereal grains in particular in association with other acid-producing meat-derived proteins. The solution is not to stop eating meat. The solution is to eat less refined cereal grains and replace them with low glycemic plant carbohydrate. We are coming up on another break. When we come back, I am going to address a couple of the issues that I think are really paramount in the discussion of soy protein and the associated isoflavones found in soy as it relates to their ability to modulate estrogen receptor activity. We will take quick break and then we will come back and talk about that.

[Music Interlude]

Dr. Connelly: Okay, welcome back everybody. One of the clear and distinguishing features of soy intake is its delivery of compounds which have definitive estrogenic activity; hence the term phytoestrogens and people should again recognize that phytoestrogens are not simply the isoflavones found in soy. There are many, many different kinds of phytoestrogens that are contained in a dietary constituent. Soy is kind of remarkable and it kind of has the whole spectrum of these compounds wearing all the way from _to a very esoteric compounds like equol and so forth but nonetheless all of these compounds have a sort of similar chemical, structural characteristic. They are all what we call phenolic compounds and obviously in another show, we kind of started the discussion of polyphenols found in berries and resveratrol sources like wine etc, etc, and those are going to be discussed at great length in many, many other shows in the future, but for now just understand that phytoestrogens do not drill down to just genistein and daidzein derivatives from soy. There are many food sources of compounds that are considered phytoestrogens and they have a lot of common characteristics which had been considered beneficial for human metabolism, possibly the most commonly described trait is there you know relatively  pristine antioxidant capabilities, but for now I would like to focus on the issue, which is a real issue, from my  perspective and understanding of the literature as a clinical  physician what are the implications of these phytoestrogen compounds with respect to a couple of areas of human physiology and medicine, and the first and foremost is reflected as the issue of what are the effects of these things if they are delivered into the  diet in quantity at different points along the lifespan, and in the united states as we have discussed on another show, in 1999 the FDA issued a health claim for soy that was ascribing or defining its effects on mitigating cardiovascular disease risk factors. Now, that was a seminal event in the commercial industry of soy because in, like I said, in 1999 the proclamation was issued that this is great for heart health and instantly there was _ of new product introductions, all of which resoundly echoed this claim and in fact I looked up the data and between 2000, just a year after the introduction of the claim and in 2007, there are almost 3,000 new soy products, food products introduced in the US market alone and the sales of these kinds of products increased from approximately 300 million bucks in 1992 to over 4 billion dollars in 2008. So obviously, there was a significant commercial market development around this particular FDA ruling, and a recent survey amongst US consumers found that 84% of people questioned had a very positive perception of soy as a health food product with almost a third saying that they purposely and intentionally seek out and consume soy or soy products at least once or twice a month. So that is a pretty significant success marketing venture as represented by the growth in the sales and so forth. Now, what this unfortunately also means is that the consumption of these types of products is now rising geometrically because soy is not only found as supplements or things like _and whatever other products we kind of discussed briefly, but you know textured soy has enormous functionality and as such is used in over 60+ % of all processed food in the United States. There are meat replacers, there is all kinds of uses for soy that are hidden below the surface and that combined with the obviously ever increasing use of high potency isoflavones-concentrated products spells a dramatic departure from what all of the typical epidemiologic studies in the far east as suggested is healthy intake. The rumour now, we were not only talking about distinguishing between differences in ethnic groups which are substantial but we are also talking about a transformation in the amount and the form of a product which whose habitual intake in the far east does not resemble in any way, shape, fashion or form the characteristics of soy intake in western culture particular in the Unites States. We now know that for example, a vegetarian in the US can attain phytoestrogen plasma levels that are considerably, and I mean considerably, above the plasma levels that are observed in Asian populations who consume them sort of habitually and one of the most alarming issues which needs to be resolved emergently in my view is the effect that these kinds of consumption has on newborn infant. One of the problems with the successful marketing campaign of soy is to convince new mothers who are unable or unwilling to breastfeed, that formula soy containing infant formulas are vastly superior to milk-based ones. That has resulted in the commandeering of about 25%-30% of the total infant formula as now a soy-containing product market landscape. That would not be so alarming except for the fact that infants, as a function of their weight, who are exclusively fed these kind of soy-based formulas, have the highest mean daily consumption of total isoflavones of any human population ever studied that result in plasma concentrations of some of these things exceeding a thousand nanograms per millilitre. That is just orders of magnitude higher than the highest levels in adult oriental humans and the problem with this is that we know for certain that these compounds can in fact affect directly estrogen receptors which mean they have the potential of having endocrine effects on newborns that are untoward in the extreme. One of the interesting sort of paradox here is that few people realize that soy protein and the isoflavones derived from it, fall under the definition that of what the environmental agency called an endocrine disruptor compound, an EDC. Now you may not realize that particular time but most people realize the brouhaha that has been building things like BPA and some of plastic derived endocrine disruptors that people now in the EPA are going wild about in terms of seeking really aggressive regulation of their propagation in the population and the effects that they could potentially have on altering the structure or function of the endocrine system which is by definition an EDC and yet at the same time you have the FDA issuing basically food claims saying this stuff is great for you without really having any substantive evidence to back that up and the FDA taking its time in re-evaluating that statement. They decided in 2007 after the American Heart Association body slammed them about the cardiovascular lipoprotein level effects that they were claiming. They initiated a sort of another look, a second look in 2007 and they are still looking, and this claim is still out there. In the mean time, these other endocrine disruptor compounds are routinely finding their way on to News magazine, TV documentary-type programs which are tempting to document. All of the havoc that they are wreaking on the human population and where this is particularly relevant is in the human condition where these levels that are attained by vegetarians and people who are aggressively supplementing can have significant untoward effects. One of the interesting things that happened some years ago was a report from the downstate medical center _, where a clinical report describing the complaints of three different female patients, middle-aged people who were presenting for unique constellation of symptoms that are reflective of gross disruption of their reproductive cycling and it was all attributed to ridiculously high levels of soy consumption in these three individuals. When they ceased consuming these things, all their symptoms disappeared. So it is probably relevant to understand, first and foremost, that these things do in fact interact directly and indirectly with very potent pathways that are sensitive to estrogen and we have reviewed last time, there are two main types of estrogen receptors, alpha receptors and beta receptors. They vary on their effects on tissues, they vary in their distribution in tissues. The one fact that is fairly consistent is that these phytoestrogens seem have a pronounced effect in the estrogen receptor beta variety of these things as opposed to the alpha, but being EDC’s they are known to act both as sort of stimulatory compounds and inhibitory compounds and that is very similar to a group of drugs that are called estrogen receptor modulators, most common of which is a compound called tamoxifen and tamoxifen has both estrogen-like activities and estrogen inhibitory activities, and tamoxifen is frequently prescribed as part of the regimen for preventing recurrence in breast cancer patients and these compounds can act just like tamoxifen-type compounds can; therefore, their effects are not entirely predictable at any level and in particular since there is no consensus about which component of the phytoestrogen is doing what amount you have to ingest in order to reach a thresholds where adverse effects would be seen and what period of time these effects can be manifested. One of the alarming things is that it is now firmly established that estrogen-like effects can occur independent of the classical hormone DNA pathways that are now may pathways that circumvent the nuclear receptor or hormone response element pathway and exert effects directly in thy cytosol which is a scary prospect if you are a newborn. So it is one thing to say that adding modest amount of soy foods, and I emphasize soy foods because again the Asian experience is not with anything other than the typical _ and soy flour and sulfur. These people do not take concentrated isoflavones supplements or S-equol or anything like it and their plasma levels are typically lower than a human who is aggressively supplementing with compounds like that and it is not clear at any point or at any review of the literature what the effects of these things have on human reproductive cycles.  The most comprehensive analysis was published in 2009. It was one of these meta-analysis things where they try to take a look using qualified criteria at all published trials out here before_ and looking at precisely that question like what can these things do to real, live human females with respect to usual and customary aspects of reproductive cycling and they concluded that isoflavone  intake, regardless of source, definitely increases menstrual cycle length and definitely suppresses both LH and FSH levels. That particular conclusion is entirely consistent with what was observed in the three case studies published at from downstate and it plause to the notion that going overboard with these things because you have been told by the media including the FTA that they are really great for you is not going to produce problems and as I have said is the issue with respect to the infant formula is particularly egregious because of the enormous penetration into the market place of these soy formulas. Again, based on the illusory premise that they are somehow healthier than milk-based thinks that particular story has a little bit of new arms to it which I would like to discuss after we take our last break here and kind of sum up with sort of an overview of what I feel is a reasonably perspective on these compounds and how they should be used in a supplemental consumption regimen. So last music break and we will be right back.

[Music interlude]

Dr. Connelly: okay, we are going to touch on again on some specifics on these issue of phytoestrogen disruption of endocrine system functionality with a sort of focused discussion on infant formulas because in my estimation, this is where the most parallel lies with respect to an illusory health benefit and a sort of deemphasized discussion of potential risks. Again, to reiterate, these compounds have the same molecular characteristics and potential toxicities that compounds in the environment from plastics and other sources posses and whereas those compounds have become, especially recently in the last five years, the scourge of the federal government and regulatory agencies, notably the EPA. These compounds which have actually very higher intrinsic  estrogenic activity on very similar molecular profiling in terms of downstream targets as these compounds in the environment have, have basically been flourishing and supported in part by an FDA health claim. One of the things that is sobering about this is that if you look at some of the coral areas with respect to the increasing intake of soy especially by younger and younger individuals – fact that manipulation of the estrogen in particular during specific high vulnerability development periods of time and especially in gestation, and when you know that these isoflavones can in fact cross the placenta and gain access to the fetus, and if that is compounded in early infancy by a total delivery of soy-based infant formulas, you are setting yourself up for some problems because the quantitative results of these soy formula consumptions are particularly ominous many infants who consume usual and customary amounts of the doses prescribed on the products for their use will get anywhere between 6 and 9 milligrams of any particular isoflavone per kilo of body weight per day and if you adjust that for body weight, it is several orders of magnitude higher than the equivalent milligram per kilogram of body weight FDA consumption guideline for adults or Asians who consume traditional soy-based diets which usually typically deliver anywhere from 0.3 to 1 milligram per kilogram per day. Now an infant fed that amount of soy formula will have as I said before typically circulating phytoestrogen concentrations in plasma of up to a thousand nanograms per ml. Let me give you some perspective on that. That is 13 to 22 thousand times higher than their own endogenous estrogen levels. It is 50 to 100 times higher than the estradiol levels in a pregnant woman and 3, 000 times higher than estradiol levels occurring at ovulation and these blood levels, which are grossly in  excess of what the Asian population epidemiology literature is based on, are high enough to produce many of the physiologic effects observed in research animals who are given super physiologic doses and they can amount to the same kind of tissue and organ  dysfunction that has been observed in human adults taking large doses of supplements. Additionally, they are at least an order of magnitude higher than those reported for other endocrine disruptors including BPA and those are facts. So determining that the use of soy in infant formula can have long-term disruptive effects on reproductive health of humans is becoming a public emergency and one that is not being addressed in my view. One of the aspects that is alarming is that the notion of these particular products propensity for endocrine disruption is perhaps mirrored in some very disturbing public health trends in all western nations projecting_ in the Unites States and Europe, the median age of menarche, first breast development and social precocity has increased steadily especially among  minority population who tend to eat the cheaper soy-based processed foods, and similar trends have been documented among children adopted from developing countries by western families. So among these data are indications that the female reproductive capability is declining even amongst younger women and the rate to which that particular anomaly reproductive infertility has been increasing is really not even been assessed in any quantitative way. The role of these phytoestrogens in the disruption of male reproduction is similarly unknown because of lack of a conspicuous examination of intake as a function of puritive  development. One of the disturbing things is that some of the male-related issues that I have seen to be correlated with these kind of increasing isoflavone intake, particularly in Europe where the data is better, is that sperm count and male infertility in some studies, again largely from Europe, have increased 30%, rates of testicular cancer are also on the rise and basically we have already said that the cause of these reproductive health trends is unknown and highly likely to be extremely _ and complex, multifaceted, but the speed or the trajectory of the increase in these disturbances is alarming to say the least and anomalous, and because of the fact that the soy market has increased so substantially in parallel with it and the observations from excellent animal studies that these things have definitive effect at the tissue and cellular level and that these effects are as potent as the native hormones needs to be addressed.  The last thing we are going to talk about is the context _ consumption of these things within the setting of the risk of breast cancer and the recovery phase, incidence and possibility of recurrence in breast cancer, and again this is an area of research that really is as clear as mud and basically that is an unfortunate situation because this is situation in which you would not want to make an error. There has been all kinds of play in the market place that has been fuelled by the desire, of females in particular, to embrace any and all “natural” remedies to help mitigate the risk of recurrence for a breast cancer once they have been successfully treated. Many individual physicians are loathed to prescribe any kind of estrogenic compound in this setting because of the issue of hormone response of breast cancer recurrence. Yet, women think that because soy is a natural product and because there are plenty of examples in the marketing of these things about their beneficial effects on the female reproductive system and estrogen tissue in particular, that they  dismiss the consequences of consuming these things separate and distinct from pharmacologic hormone therapy and they just blindly embrace the consumption of these products, and I guess there is no purpose in trying to sort out all the mol_lass of confusing data about this but from the stand point of what is in the literature, I would say that there is no compelling evidence whatsoever that these phytoestrogen compounds can ameliorate the menopausal symptoms that are seen in post breast cancer patients.  For some reason, menopause post breast cancer patients have exaggerated menopause and have their quality of their lives disrupted tremendously  by it and therefore there is a tremendous motivation for these patients to seek relief from their menopausal symptoms and therefore they are attracted to the notion that the soy will not have the risk of recurrence and ameliorate them. I think I can emphasize that the overall opinion of the medical literature is that there is not any real convincing evidence that these things will have that effect. One of the problems with menopausal treatment regimen that is notorious is the effect of placebo which is extreme in these particular circumstances because of the fact that many of the symptoms, especially the vasomotor _ sweating and all that stuff, are subject to very, very, very extreme degrees of subjective difference in interpretation and degree of difficulty, but there is an issue with respect to the intersection of these compounds and their ability to function as modulators or the same things as the tamoxifen and that is that there is pretty convincing evidence that they can sort of mess up the effect of tamoxifen in a post _ protocol and therefore I think probably my opinion would be that women who are pregnant, women who have had breast cancer, who are at particular risk for breast cancer because of a strong family history or because of the presence of BRCA gene, will probably best be served by staying away from soy products.  That is not a definitive answer by any stretch of  imagination because as I said, the reality of this literature is that it is as clear as mud, but there is enough negative information out there to suggest caution with respect to this particular application and as I said, it is an area that you really do not want to make a mistake and there is plenty of opportunity for robust, health promoting protein consumption that excludes soya as a source and for these particular applications that involve carcinoma of the breast, recurrent carcinoma of the breast. The reality that these compounds do in fact  importantly or significantly interact with the estrogen receptor and have downstream effects on tissue and organ functionality, it is probably not a good idea to mix them into your dietary strategy if you are in that particular category. I think next time we are going to have some sort of somewhat summary of protein and protein supplementation for people who have not had the opportunity to listen to the individual episodes. It is probably reasonable to provide an aerial review of some of the pros and cons of both dairy and soy supplementation. So I think that is probably what we are going to have up next on the agenda. Until that time. Remember, “Fat, drunk and stupid is no way to go through life!”

About the author

george harris NLP Hypnotherapist, outdoor fitness and hill walking leader and nutritional therapist living and working in Kendal and the Lake District. Taking hill walks and weekend events for Large Outdoors. Seeing hypnotherapy clients who want to lose weight, stop smoking and lots of other issues. It's the best and most satisfying work I've ever done; helping clients make profound changes to their lives is an honour and a privilege.