Dr. Gordon Saxe,M.D., Ph.D., Research Director and Preventive Medicine Physician at the UCSD Center for Integrative Medicine and co-developer Medical Director of the UCSD Natural Healing & Cooking Program, gave us all the details about soy, your health, and its effects on menopause in Soy to the World Part I. He answered all the most pressing questions about soy and menopause symptom relief, giving women hope that soy may help hot flashes, among others. We received such great feedback that we asked Dr. Saxe to share some of his most favorite (and VERY easy) recipes that incorporate soy into a diet. We also asked Dr. Saxe to give us his take on the recent study published in the Journal of Women’s Health suggesting that a new fermented soy ingredient containing s-equol improved menopausal symptoms in postmenopausal Japanese women, including significantly reducing hot flush frequency. Here’s part two of Soy to the World from Dr. Saxe:

In the first part of this blog, we discussed the pros and cons of soy for perimenopause and menopause and other health concerns of women. One of the conclusions was that one of the oldest, safest, and healthiest ways to use soy is in the form of fermented soy foods such as miso and tempeh. Unlike most non-fermented soy foods (other than tofu), fermented ones do not contain trypsin inhibitor – a compound that interferes with the body’s ability to properly digest soy. Fermented soy foods, particularly miso, also contain active cultures that are beneficial for intestinal health.

While tofu is not a fermented soy food, the precipitation process used in its production greatly reduces trypsin inhibitor, thereby making it more digestible. Tofu has the added advantage of incredible versatility – it takes on the flavor of just about anything it’s added to and can be used in everything fromsoy  stir-frys to lasagna to vegan cheesecake!

This study certainly underscores the potential benefit of s-equol for hot flushes, and that’s exciting! However, taking s-equol as a nutraceutical raises a couple of questions for women.

(1) Are there any safety concerns, particularly with higher doses or long-term use?

Normally, gut flora act on ingested daidzein (the second most abundant soy isoflavone – after genistein – in soy foods) to produce the metabolite s-equol. Those with sufficient flora to produce s-equol typically have milder menopausal symptoms than those who cannot metabolize dietary daidzein to s-equol. It’s one thing for the body to produce s-equol at the rate that it is naturally capable of. It is another to throw it at the body like a drug. There may be unintended consequences and the study was not adequately designed to fully detect them.

(2) How can we naturally enhance the body’s own ability to produce s-equol?

Interestingly, about 50% of Japanese women, compared with only about 25% of American, have the ability to produce s-equol from the daidzein in soy foods. There are several possible answers – each with potential lessons for the prevention or treatment of hot-flushes and other perimenopause and menopause symptoms:

Among them are that we need to place more focus on improving gut ecology and cultivating adequate levels of the right flora to permit natural production of s-equol. To do this, we need to regularly consume foods containing active cultures. When you mention active cultures, the first thing most people think of is Dannon or Yoplait or other yogurt from dairy. We’ve been well-programmed! But it seems intuitive to me that that the foods most likely to provide the flora specifically responsible for the daidzein to s-equol conversion would come from fermented soy. This would include miso, tempeh, natto, and soy yogurt or kefir.

In addition, we need to have adequate dietary intake of soy foods to provide sufficient levels of daidzein – the substrate for production of s-equol. As we discussed in the first soy blog last November, the are a multitude of reasons why whole fermented soy foods are much better than soy powders or shakes containing concentrated isoflavones.

Finally, there may be other things in the diet that can naturally enhance conversion of daidzein to s-equol. One possibility is seaweed – a type of food prominent in Asian diets but not those in the U.S. The trace minerals in seaweed are important for facilitating a variety of healthy biochemical processes, possibly including the conversion of daidzein to s-equol. In addition, seaweed is soothing to epithelial linings such as those of the intestines and may help promote gut health more generally.

So, putting it all together, it would seem to me that the best way to derive sufficient s-equol to help combat hot flushes is with whole fermented soy foods. In this regard, miso soup may be a real “three-fer.” First, as a soy food, miso contains lots of the precursor daidzein. Second, it is a rich source of active cultures – including, I suspect, the ones specifically needed to promote s-equol production. And third, the seaweed used in miso soup may add to this effect.

One of the recipes I’ve included is for miso soup with wakame – a delicate form of the seaweed kelp. Wakame has about 10 times as much calcium – ounce for ounce – as milk and is excellent for bone health. Wakame has also been traditionally used with miso for centuries. Perhaps there’s some ancient wisdom here.

And one final note on miso: The best brands, in my experience are South River and Ohsawa (no, they don’t pay me to say this!). These brands use organic, non-GMO soybeans, unrefined sea salt, NO MSG, and age the miso in casks for periods from 1 – 3 years, resulting in miso bursting with active cultures. They can both be ordered from Goldmine Natural Foods (a natural food distributor — based here in San Diego – with an outstanding product line) at www.goldminenaturalfoods.com.
Here are a few starter recipes — you can check these out, try variations on a theme, or look up any of the hundreds of recipes using these soy foods that are available online.

Miso Soup with Onion, Carrot, Bok Choy, and Tofu

A delicious and easy-to-make soup that’s good for whatever ails you! It also contains wakame – a form of kelp – that’s pleasant tasting, rich in trace minerals, and naturally detoxifies the body! (Hint: Miso and wakame can both be obtained at most natural grocery stores.)

Ingredients:
6 cups water
1/2 cup onion, sliced thin
1/2 cup carrots, julienned
1 cup bok choy, chopped
1 piece wakame, 4 inches long or 2 tsp. wakame flakes
1/4 pound organic tofu, sliced into small cubes
2 1/2 tablespoons organic barley or brown rice miso
1/3 cup scallions, minced

Directions:
1. If using the long pieces of wakame, rinse and soak for 10 minutes in cold water to cover. Remove and discard soaking water. Chop the wakame into small (1Ž2 inch) pieces. If using instant wakame flakes, there is no need to rinse or soak. Place the chopped wakame or wakame flakes and water in a pot, cover and bring to a boil.
2. Add onions and carrots.
3. Cover, reduce flame to medium low and simmer 5 minutes.
4. Reduce the flame to low. Dilute miso in 1Ž4 cup of the hot soup broth and add to the soup.
5. Add bok choy, and tofu, and allow to simmer without boiling for 2 minutes.
6. Garnish with scallions and enjoy! (Makes 6 servings)

Broiled Tempeh
This simple tempeh recipe makes a savory appetizer or tasty side dish . . .

Ingredients:
1 8-oz package tempeh, pre-steamed for 15 minutes
4 large mushrooms, chopped
4 cloves garlic, chopped
3 teaspoons grated fresh ginger
4-6 tablespoons tamari (naturally brewed soy sauce)
2 tablespoons fresh chopped parsley

Directions:
1. Lightly coat a Pyrex pie plate with cold-pressed sesame or extra virgin olive oil.
2. Add in 1/4 of the tamari.
3. Cut the tempeh into small bite size pieces and place in the pie plate.
4. Add the chopped mushrooms, garlic, and ginger.
5. Sprinkle remaining tamari on top.
6. Sprinkle with parsley.
7. Broil 6″ from heat source for approximately 10 minutes or until the tamari is bubbling and the tempeh is browned.
8. Serve and enjoy! (Makes 4 servings)

Tofu Whipped Cream
This simple, creamy dessert sauce keeps for several days and can be used in place of whipped cream with fruit, cakes, or tarts. And it only takes 5 minutes to make!

Ingredients:
1 lb extra-firm tofu
1/3 cup maple syrup or agave nectar
1 tablespoon cold-pressed sunflower or safflower oil
1 tablespoon soy milk
1 1/2 teaspoons vanilla extract
1 teaspoon lemon juice
1 pinch sea salt

Directions:
1. Whip all ingredients together in food processor or blender until very smooth.
2. Refrigerate at least two hours before serving.
Serve and enjoy! (Makes 8 servings)

Even if soy doesn’t quite work for your hot flashes, you’ll have a great, healthy meal! Thank you to Dr. Saxe for his extensive knowledge on soy and for his delicious recipes!

Gordon Saxe, MD, PhD is the Director of Research, a preventive and integrative medicine physician, a founding member of the UCSD Center for Integrative Medicine, and co-developer of the UCSD Natural Healing & Cooking Program.

Remember: Suffering in silence is OUT!  Reaching out is IN!