Soy Protein and Serum Cholesterol Reduction

Transcription

1 Soy Protein and Serum Cholesterol Reduction David J.A. Jenkins Department of Nutritional Sciences, Faculty of Medicine, University of Toronto; Clinical Nutrition & Risk Factor Modification Center St. Michael s Hospital Ontario, Canada

2 Colleagues Arash Mirrahimi, Korbua Srichaikul, Claire E. Berryman, Li Wang, Amanda Carleton, Shahad Abdulnour, John L. Sievenpiper, Cyril W. C. Kendall, and Penny M. Kris Etherton J. Nutr. 140: 2302S 2311S, 2010 Sonia Blanco Mejia, Siying S Li, Effie Viguiliouk, Laura Chiavaroli, John L Sievenpiper, Penny Kris Etherton, Mark Messina. Unpublished

3 Conflict of Interest Barilla, Italy A general food company. Producer of pasta and baked goods. G Solae, St. Louis The major US producer of soy protein isolate. C,G Unilever, Vlaardigen,Netherlands Major margarine producers including Becel and Take Control (plant sterol enriched margarine). G, GP Haine Celestial, CA One of the largest Health Food companies in the US. G Loblaws Supermarkets Canada s largest supermarket chain. G, SAB Sanitarium Company, Sydney, Australia Australia s largest health food manufacturing company and soy food producer. G, SAB Epicure C, H C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

4 Conflict of Interest Herbalife International, Century City, CA A nutraceutical company with an emphasis on sourcing plant derived components for weight loss. SAB Nutritional Fundamentals for Health, Montreal, QE A new nutraceutical company exploring and aiming to market food derived components for health. SAB Pacific Health Laboratories INC, Matawan, NJ a nutrition technology company with functional food and nutraceutical products researched and commercialized for sports performance weight loss and type 2 diabetics which can be marketed without prior approval of the FDA. SAB, Stock Metagenics/MetaProteomics, Gig Harbor WA a company assessing natural products from hops which will positively impact individuals with specific genetic susceptibilities for chronic disease. SAB C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

5 Conflict of Interest Bayer Consumer Care, Springfield NJ Marketing of nutritional supplements/nutraceuticals. SAB Oldways Preservation Trust, Boston, MA A not for profit organization promoting traditionally healthy ways of eating (eg. Mediterranean Diet, etc.) H Almond Board of California, Modesto, CA A branch of the USDA (therefore not for Profit ) to promote the use of almonds. C,H,G The California Strawberry Commission, Watsonville, CA Another USDA not for profit group to explore possible health benefits and to promote the use of strawberries. SAB Orafti, Tienen, Belgium Development of prebiotics for modification of colonic microflora. SAB, G C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

6 Conflict of Interest Unilever Canada Guidelines for the management of hyperlipidemia. G,C,H Agriculture and Agrifoods Canada (AAFC) SAB Canadian Agriculyure Policy Institute (CAPI) SAB White wave Dean Foods, Colorado SAB, C, H Orafti, Tienen, Belgium Development of prebiotics for modification of colonic microflora. SAB, G Wife and is a Director of Glycemic Index Laboratories, Toronto, CA Financial relationship of a spouse Kellogg s, Canada C, H, SAB Quaker Oats, Canada C, H, SAB The Coco Cola sugar Advisory Board. C, H,SAB Griffin Hospital, New Haven For the development of the Nuval System. C, H, SAB C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

7 Conflict of Interest Abbott Laboratories, Algorithms for Diabetes Management. C, H, SAB The Canola & Flax Councils of Canada. C, H,SAB Pulse Canada SAB Saskatchewan Pulse Growers SAB Canadian Institute of Health Research (CIHR) G Canadian Foundation for Innovation (CFI) G Ontario Research Fund (ORF) G Advanced Foods and material Network (AFMNet) G International Tree Nut Council Nutrition Research and Education Foundation and the Peanut Institute G, H Alpro Soy Foundation H Vegan for last 10year (Vegetarian since 12y, B 12 deficient?) C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

8 Soy History 1. Anderson et al NEJM g soy protein/d= LDL C 12.5% 2. FDA Soy Health Claim AHA Soy Advisory 2006 = LDL C 3 4% (intrinsic) 4. FDA proposal to revoke Soy Health Claims 2017

9 The Evidence Neither the AHA or FDA based their concerns on meta analyses of RCTs They arrived at their conclusions by stating that most individual studies (often small numbers) did not reach significance Hence we believe meta analyses are REQUIRED

10 AHA Advisory Soy Studies J. Nutr. 140: 2302S 2311S, 2010

11 AHA advisory ~ 4.3% LDL C reduction (p<.0001)

12 Same Meta analysis approach with 46 FDA 2017 trials ~ 3.2% LDL C reduction STILL (p<.0001)

13 Other FDA Health Claims: Nuts 40g ~ 4% LDL C β-glucans oats 3.5g ~ 5% LDL-C = Similar order of magnitude

14 BUT Add Meat and Dairy SFA displacement value When Soy foods are used

15 LDL C Change % LDL reduction J. Nutr. 140: 2302S 2311S, 2010

16 Soy substitution for Animal Protein Foods LDL C reduction bar graph FIGURE 2 Change in LDL C due to dietary displacement by soy protein at the average fatty acid intake reported in the NHANES III population assessment J. Nutr. 140: 2302S 2311S, 2010

17 Soy Effect Endogenous LDL C reduction =3.2% * + Displacement LDL C reduction =3.6% 6.0% Total LDL C reduction = %

18 How do we use soy as a part of a combination a Dietary Portfolio

19 What happens if you combine these cholesterollowering components (Portfolio Diet)? % LDL reduction NCEP step 2: 10 % Portfolio Diet: viscous fiber 5 % soy & legumes proteins 5 % plant sterols 5 % almonds 5 % TOTAL 30 % LDL reduction = 1 st generation Statin after Jenkins DJ, Kendall CW, et al. Curr Opin Lipidol 2000

20 Key Mechanisms of Action 1. Viscous fibers = Bile acid losses 2. Soy Protein = Cholesterol synthesis LDL receptor uptake 3. Phytosterols = Cholesterol absorption 4. Almonds + multiple mechanisms

21 Dietary Portfolio Study Foods: Readily available in supermarkets. Nuts: ~30 g/d almonds Viscous Fiber: ~20 g/d oats, barley, psyllium, legumes, eggplant, okra Vegetable Protein: ~80 g/d (50% soy) soy, beans, chick peas, lentils Plant Sterols: ~2 g/d plant sterol margarine Jenkins DJ, Kendall CW et al. Metabolism 2002

22 Dietary Portfolio: Changes in LDL C 10 LDL Cholesterol 5 0 % Change From Baseline Control Portfolio Statin -40 Wk 0 Wk 2 Wk 4 Jenkins DJ, Kendall CW et al. JAMA 2003

23 Dietary Portfolio Changes in C Reactive Protein 10 C-reactive Protein 5 0 % Change From Baseline Control Portfolio Statin -40 Wk 0 Wk 2 Wk 4 Jenkins DJ, Kendall CW et al. JAMA 2003

24 Portfolio dietary pattern on cardiometabolic outcomes Chiavaroli L et. al. Prog Cardiovasc Dis May Jun;61(1):43 53

25 INFLAMMATION Forest plot of our randomized controlled trials on the effect plant based (no meat) low saturated fat low cholesterol diets (Dietary Portfolio) on CRP (n=439) JAMA JAMA CMAJ CMAJ Metabolism JAMA Metabolism Chiavaroli L et. al. Prog Cardiovasc Dis May Jun;61(1):43 53

26 Recent Evolution of More Plant based Dietary Guidelines for the public 1. Sweden (2009) first to incorporate environmental concerns into dietary guidelines 2. Netherlands(2015) no more than 2 servings of meat per week 3. USA (2016) vegetarian diet (1 of 3 healthy diets) 4. China (2016) reduce all meat consumption by 50% 5. UK(2016) eat more beans and pulses, eat less red and processed meat 6. Belgium (2017) make foods derived from plants the basis of every meal, limit your intake of animal products 7. Canada? Going in Same Direction 74

27 Soy in Portfolio in Guidelines Soy has been included in numerous clinical practice guidelines for CVD risk reduction 1. National Cholesterol Education Program [NCEP] Adult Treatment Panel [ATP] III update Heart UK 3. European Atherosclerosis Society [EAS] Statin associated muscle symptoms [SAMS] advisory 4. Canadian Cardiovascular Society [CCS])

28 Summary 1. Soy lowers serum LDL C by intrinsic mechanisms by ~3.2% (p<.0001) 2. Soy likely lowers LDL C by other food displacement by an additional 3 6% 3. Soy is likely to have an overall reduction of LDL C of 6% 9% 4. Soy forms part of dietary recommendations to lower LDL C internationally e.g. dietary portfolio 5. Perhaps some of the resistance to soy food consumption comes from the fact that soy protein is one of the few plant protein sources that can substitute for meat and dairy to address the international dietary guidelines requirement to eat more plant protein and less animal protein foods