increased susceptibility to fractures, particularly
fractures of the vertebrae, distal forearm (Colles
fracture), and hip. Of these, hip fracture is the most
severe, since patients require a lengthy hospital stay,
there is a high mortality rate (about 20% within 6
months of the fracture), and of those who survive,
many suffer permanent disability and dependency.
Osteoporosis is a major health problem in many
Western countries, but not in Asian countries. A
number of factors are known to increase the risk of
osteoporosis, including insufficient dietary calcium,
low physical activity, and lack of estrogen.
0036 In women, bone mass reduces at a rapid rate in the
first few years after the menopause, owing to the
reduction in estrogen. Hormone-replacement therapy
(HRT) is well known to reduce bone loss in postme-
nopausal women. However, HRT is not appropriate
for all women. Since soya may have estrogenic effects,
it has been hypothesized that it may provide an alter-
native to HRT.
0037 Soya protein containing isoflavones has been
reported to reduce bone loss due to estrogen defi-
ciency in ovariectomized rats. Soya bean isoflavones
have also been shown to have a protective effect on
bone loss in ovariectomized rats, suggesting that the
beneficial effect of soya protein is due to isoflavones.
The effect of isoflavones on bone loss in rats has been
reported to be similar to that for estrogen. The bone-
sparing effect of soya protein isoflavones has been
suggested to be due to a reduction in bone resorption
and/or to an increased osteoblast activity (increasing
bone formation).
0038 In humans, most but not all studies indicate that
soya protein containing isoflavones favorably affects
bone turnover and bone mineral density in the lumbar
spine of perimenopausal and postmenopausal women.
Treatment with ipriflavone, a synthetic isoflavone,
has also been reported to have bone-conserving
effects in postmenopausal women with a low bone
mass, thus confirming that the beneficial effect of
soya protein is likely to be due to isoflavones.
0039 In addition to the effect of soya protein on bone
mineral density, it has also been suggested that
soya protein, when substituted for animal protein,
may indirectly enhance bone strength. Another effect
of soya protein is that it helps to conserve calcium
by reducing urinary calcium excretion. This is due
to the lower sulfur amino acid content of soya
protein.
0040 Soya protein therefore appears to have modest
beneficial effects on bone density. However, studies
to date have been short term and have involved only
small numbers of subjects. In addition, no study has
investigated whether soya protein containing isofla-
vones has an effect on fracture risk.
Soya and Menopausal Symptoms
0041Hot flushes (also known as hot flashes) are a common
symptom among menopausal women in Western so-
cieties but are reported to be much less common in
Japan. Whether this difference is due to the higher
consumption of soya in Japan is not clear. HRT gen-
erally alleviates hot flushes and other menopausal
symptoms such as vaginitis. There is much research
interest in the possibility that soya may provide an
alternative to HRT in this regard.
0042Evidence of benefit of soya in menopausal women
is conflicting. Some researchers have reported an im-
provement in the frequency of hot flushes in women
taking soya protein daily. Others have reported no
effect of soya protein on the number of hot flushes
experienced but found a reduction in the severity of
symptoms. Others have reported a reduction in both
the incidence and severity of hot flushes with soya
protein or an isoflavone extract compared with a
control group. Others have reported no difference in
either the frequency or severity of hot flushes in the
intervention group compared with the control group.
0043Two studies have investigated the effects of
phytoestrogen supplements on vaginal cytology and
found an increase in cell proliferation (an indication
of estrogenic activity) and reversal of menopausal
atrophy. Others have reported no significant effect.
0044There are difficulties in interpreting the results of
these studies. This is because there are differences in
the amounts of soya protein and isoflavones used and
differences in the duration of the studies. Interpret-
ation is also complicated by the fact that the reported
frequency and severity of symptoms tend to decrease
in the control group as well as the intervention group.
Thus, much more research needs to be done before
soya protein can be proposed as a potential alterna-
tive to HRT for the control of menopausal symptoms.
See also: Amino Acids: Properties and Occurrence;
Anemia (Anaemia): Iron-deficiency Anemia;
Atherosclerosis; Cancer: Epidemiology; Diet in Cancer
Prevention; Cholesterol: Factors Determining Blood
Cholesterol Levels; Role of Cholesterol in Heart Disease;
Colon: Cancer of the Colon; Coronary Heart Disease:
Etiology and Risk Factor; Prevention; Dietary Fiber:
Physiological Effects; Bran; Osteoporosis; Plant
Antinutritional Factors: Characteristics; Vegetarian
Diets
Further Reading
Anderson JJB, Anthony M, Messina M and Garner SC
(1999) Effects of phyto-oestrogens on tissues. Nutrition
Research Reviews 12: 75–116.
Anderson JW, Johnstone BM and Cook-Newell ME (1995)
Meta-analysis of the effects of soy protein intake on
SOY (SOYA) BEANS/Dietary Importance 5397