phytoestrogens and Diabetes-Mellitus

Flaxseed is the richest source of the lignan secoisolariciresinol diglucoside (SDG). After ingestion, SDG is converted to secoisolariciresinol, which is further metabolised to the mammalian lignans enterodiol and enterolactone. A growing body of evidence suggests that SDG metabolites may provide health benefits due to their weak oestrogenic or anti-oestrogenic effects, antioxidant activity, ability to induce phase 2 proteins and/or inhibit the activity of certain enzymes, or by mechanisms yet unidentified. Human and animal studies identify the benefits of SDG consumption. SDG metabolites may protect against CVD and the metabolic syndrome by reducing lipid and glucose concentrations, lowering blood pressure, and decreasing oxidative stress and inflammation. Flax lignans may also reduce cancer risk by preventing pre-cancerous cellular changes and by reducing angiogenesis and metastasis. Thus, dietary SDG has the potential to decrease the incidence of several chronic diseases that result in significant morbidity and mortality in industrialised countries. The available literature, though, makes it difficult to clearly identify SDG health effects because of the wide variability in study methods. However, the current evidence suggests that a dose of at least 500 mg SDG/d for approximately 8 weeks is needed to observe positive effects on cardiovascular risk factors in human patients. Flaxseed and its lignan extracts appear to be safe for most adult populations, though animal studies suggest that pregnant women should limit their exposure. The present review discusses the potential health benefits of SDG in humans, with supporting evidence from animal studies, and offers suggestions for future research.

Topics: Animals; Antioxidants; Butylene Glycols; Cardiovascular Diseases; Diabetes Mellitus; Diet; Enzyme Activators; Enzyme Inhibitors; Female; Flax; Glucosides; Humans; Lignin; Neoplasms; Phytoestrogens; Pregnancy

Evidence is emerging that dietary phytoestrogens play a beneficial role in obesity and diabetes. Nutritional intervention studies performed in animals and humans suggest that the ingestion of soy protein associated with isoflavones and flaxseed rich in lignans improves glucose control and insulin resistance. In animal models of obesity and diabetes, soy protein has been shown to reduce serum insulin and insulin resistance. In studies of human subjects with or without diabetes, soy protein also appears to moderate hyperglycemia and reduce body weight, hyperlipidemia, and hyperinsulinemia, supporting its beneficial effects on obesity and diabetes. However, most of these clinical trials were relatively short and involved a small number of patients. Furthermore, it is not clear whether the beneficial effects of soy protein and flaxseed are due to isoflavones (daidzein and genistein), lignans (matairesinol and secoisolariciresinol), or some other component. Isoflavones and lignans appear to act through various mechanisms that modulate pancreatic insulin secretion or through antioxidative actions. They may also act via estrogen receptor-mediated mechanisms. Some of these actions have been shown in vitro, but the relevance of these studies to in vivo disease is not known. The diversity of cellular actions of isoflavones and lignans supports their possible beneficial effects on various chronic diseases. Further investigations are needed to evaluate the long-term effects of phytoestrogens on obesity and diabetes mellitus and their associated possible complications.

Topics: Blood Glucose; Diabetes Mellitus; Diet; Estrogens, Non-Steroidal; Humans; Insulin; Insulin Resistance; Isoflavones; Obesity; Phytoestrogens; Phytotherapy; Plant Preparations; Soybean Proteins

EXECUTIVE SUMMARY This American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) Position Statement is designed to update the previous menopause clinical practice guidelines published in 2011 but does not replace them. The current document reviews new clinical trials published since then as well as new information regarding possible risks and benefits of therapies available for the treatment of menopausal symptoms. AACE reinforces the recommendations made in its previous guidelines and provides additional recommendations on the basis of new data. A summary regarding this position statement is listed below: New information available from randomized clinical trials and epidemiologic studies reported after 2011 was critically reviewed. No previous recommendations from the 2011 menopause clinical practice guidelines have been reversed or changed. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, selective estrogen-receptor modulators (SERMs), and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, SERMs, and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. New recommendations in this position statement include: 1.. the use of menopausal hormone therapy in symptomatic postmenopausal women should be based on consideration of all risk factors for cardiovascular disease, age, and time from menopause. 2.. the use of transdermal as compared with oral estrogen preparations may be considered less likely to produce thrombotic risk and perhaps the risk of stroke and coronary artery disease. 3.. when the use of progesterone is necessary, micronized progesterone is considered the safer alternative. 4.. in symptomatic menopausal women who are at significant risk from the use of hormone replacement therapy, the use of selective serotonin re-uptake inhibitors and possibly other nonhormonal agents may offer significant symptom relief. 5.. AACE does not recommend use of bioidentical hormone therapy. 6.. AACE fully supports the recommendations of the Comité de l'Évolution des Pratiques en Oncologie regarding the management of menopause in women with breast cancer. 7.. HRT is not recommended for the prevention of diabetes. 8.. In women with previously diagnosed diabetes, the use of HRT should be individualized, taking in to account age, metabolic, and cardiovascular risk factors.. AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; BMI = body mass index; CAC = coronary artery calcification; CEE = conjugated equine estrogen; CEPO = Comité de l'Évolution des Pratiques en Oncologie; CAD = coronary artery disease; CIMT = carotid intima media thickness; CVD = cardiovascular disease; FDA = Food and Drug Administration; HDL = high-density lipoprotein; HRT = hormone replacement therapy; HT = hypertension; KEEPS = Kronos Early Estrogen Prevention Study; LDL = low-density lipoprotein; MBS = metabolic syndrome; MPA = medroxyprogesterone acetate; RR = relative risk; SERM = selective estrogen-receptor modulator; SSRI = selective serotonin re-uptake inhibitor; VTE = venous thrombo-embolism; WHI = Women's Health Initiative.

Topics: Administration, Cutaneous; Administration, Oral; Aged; Amines; Breast Neoplasms; Cardiovascular Diseases; Cimicifuga; Cognition; Cyclohexanecarboxylic Acids; Diabetes Mellitus; Endocrinology; Estradiol; Estrogen Replacement Therapy; Estrogens; Excitatory Amino Acid Antagonists; Female; Gabapentin; gamma-Aminobutyric Acid; Hot Flashes; Humans; Menopause; Middle Aged; Osteoporosis; Phytoestrogens; Phytotherapy; Progesterone; Progestins; Risk Assessment; Selective Serotonin Reuptake Inhibitors; Societies, Medical; Thrombosis; Vasomotor System

The majority of instruments used to evaluate menopausal symptoms are long and complex. In this sense, more simple tests are being designed to rapidly obtain a snapshot of the global clinical picture.. To assess menopausal symptoms in mid-aged women using the short 10 item version of the original menopause Cervantes Scale (CS-10).. This was a cross sectional study in which a total of 451 Ecuadorian women (40-59 years) were surveyed with the CS-10 and a general socio-demographic questionnaire containing personal and partner data.. Median age of the whole sample was 48 years. A 41.2% were postmenopausal, 44.3% abdominally obese (waist circumference >88cm), 6% diabetic, 16.9% hypertense, 11.5% smoked, 6.9% currently used hormone therapy, 9.5% phytoestrogens and 6.7% psychotropic drugs. For the entire sample, median [interquartile range] CS-10 global scores were 10.0 [9.5], and for pre-, peri- and postmenopausal women: 5.0 [7.0], 11.0 [9.0] and 13.5 [8.0], respectively. The CS-10 displayed good internal consistency (Cronbach's alpha 0.87). According to the CS-10, the three most prevalent menopausal symptoms were: muscle and joint pains (88.5%), hot flushes (77.6%) and skin dryness (71.4%). Multiple linear regression analysis found that postmenopausal status, parity, unhealthy perceived status, psychotropic drug use, partner erectile dysfunction, lower coital frequency and living at high altitude were related to higher CS-10 global scores.. In this mid-aged Ecuadorian female sample severity of menopausal symptoms, as determined by the CS-10, were related to environmental and female/partner personal and socio-demographical aspects.

Topics: Adult; Arthralgia; Attitude to Health; Coitus; Cross-Sectional Studies; Diabetes Mellitus; Ecuador; Erectile Dysfunction; Female; Hormone Replacement Therapy; Hot Flashes; Humans; Hypertension; Male; Menopause; Middle Aged; Myalgia; Obesity, Abdominal; Parity; Perimenopause; Phytoestrogens; Postmenopause; Premenopause; Psychotropic Drugs; Smoking