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WWW.IHPMAGAZINE.COM SEPTEMBER 2015
Doctors going digital
Natural Medicine in Europe
CANCERAn Integrative Approach
001.IHP Cover_noimages.indd 7 2015-08-20 10:09 AM
contents
DEPARTMENTS
FEATURES
SEPTEMBER 2015 • IHPMAGAZINE.COM 6
9 Publisher’s Letter
10 Editorial Board
12 Bits and BitesIndustry and Research News
26 Product Pro�les
30 Clinic Pro�leIntegrative Health Institute
50 Post Scriptum
34 Doctors going digitalSocial media: friend or foe
36 Doctor’s Choice
38 Therapeutic and molecular evidence for the use of soy and red clover in breast cancer
44 An integrative approach to cancer in Canada
48 Natural Medicine in EuropeSearching for adequate methodology
�nd us on3430
38
IHP Contents.indd 6 2015-08-20 9:59 AM
SEPTEMBER 2015 • IHPMAGAZINE.COM 9
publisher’s letter
A ccording to Canadian cancer statis-
tics, the number of new cancer cases
will increase approximately 40 per
cent for Canada. Integrative approach to
treating and preventing cancer is now being
actively explored. We interviewed Dr. Dugald
Seely, executive director of the Ottawa
Integrative Cancer Centre to get some
updates on the current state of cancer
research from the integrative perspective.
In this issue, you can also find a European
perspective on the methodology currently
used by the naturopathic profession. On
page 48, president of the Association of
Natural Medicine in Europe shares her
opinion on the effectiveness of the evi-
dence-based system and its application in
the naturopathic medicine research. In our
recently introduced section, we will be
talking about social media and what you
should know to use it professionally.
September is a busy month for our indus-
try with the Ontario Association of
Naturopathic Doctors (OAND) holding their
2015 Convention and Tradeshow: Maximizing
the Power of the Mind in Total Wellness: Mind/
Body Medicine, Disease Management, and
Treatment Alternatives. We are expecting a
wonderful event on the body-mind connec-
tion in naturopathic medicine and we are
honoured to be media partner with the
OAND. Everyone attending the event will
have a chance to win a clinic makeover by
Melissa David, top Toronto designer, known
for her creative design and reno work pro-
duced for a number of HGTV shows.
If you have not done it yet, please
download your IHP App where you
have access to exclusive content and
full-length reference material.
Founder Sanjiv Jagota
Publisher & Editor-in-Chief Olivier Felicio
Managing Editor Inna Levchuk
Art Director Scott Jordan
Graphic Designer Kaitlin Yep
Contributors Jason Boxtart, Denise Cheung, Rochelle Fernandes, Eric Forget, Nora Laubstein, Dugald Seely, Jill Shainhouse
IHP Magazine Inc.
President Olivier Felicio
General Manager Melanie Seth
General Customer Care Manager Lucy Holden
Subscription RatesCanada $80 (gst included) for six issues | International $120
Canada Post Canadian Publication Mail Agreement Number 4067800 The pub-lisher does not assume any responsibility for the contents of any advertisement and any and all representations or warranties made in such advertising are those of the advertiser and not of the publisher. The publisher is not liable to any advertiser for any misprints in advertising not the fault of the publisher and in such an event the limit of the publisher’s liability shall not exceed the amount of the publisher’s charge for such advertising. No portion of this publication may be reproduced, in all or part, without the express written permission of the pub-lisher. ihp magazine is pleased to review unsolicited submissions for editorial consideration under the following conditions: all material submitted for edito-rial consideration (photographs, illustrations, written text in electronic or hard copy format) may be used by ihr Media Inc. and their af�liates for editorial pur-poses in any media (whether printed, electronic, internet, disc, etc.) without the consent of, or the payment of compensation to, the party providing such mate-rial. Please direct submissions to the Editor, ihp magazine.
Published by IHP Magazine
CirculationIHP Magazine Inc.1235 Bay St., suite 400; Toronto, Ontario, M5R 3K4Email: [email protected]
Advertising Olivier Felicio(416) 203-7900 x [email protected]
SEPTEMBER 2015 • Volume 8 Issue 4
Olivier Felicio
Publisher/Editor-in-Chief
IHP PubLetter.indd 9 2015-08-20 9:59 AM
SEPTEMBER 2015 • IHPMAGAZINE.COM 38
feature
Therapeutic and molecular evidence for the use of soy
and red clover in breast cancer
By Rochelle Fernandes, MSc., ND (cand.)
Peer-reviewed by Jason Boxtart (ND), Dugald Seely (ND, MSc), Jill Shainhouse (ND, FABNO), Denise Cheung (ND, cand)
IHP CoverStory.indd 38 2015-08-20 10:00 AM
SEPTEMBER 2015 • IHPMAGAZINE.COM 39
B reast cancer is the most diagnosed cancer for
women over 20, and is the second leading cause
of cancer deaths in women, second to lung cancer
(CCDP, 2005-2010). It is thought that 24,000 Canadians
will be diagnosed with breast cancer this year and 5000
will die from it, as stated by the Canadian Breast Cancer
Foundation (Coles 2013). Given these alarming statistics,
along with the side effects of conventional treatment (i.e.
fatigue, nausea, lymphedema, nerve damage and more),
there has been an increasing interest in the use of natural
supplements to prevent and treat cancer alone or alongside
conventional options. This growing interest has included
the controversial but promising use of phytoestrogens
found in soy and red clover. The study of soy as a therapeutic
ingredient has increased over the last decade. It has been
researched for its use in alleviating menopausal hot flashes,
diminishing bone loss, reducing cholesterol levels and in
cancer prevention (Messina 2010). There was a perceived
notion that soy phytoestrogens were weak estrogen ago-
nists/antagonists with molecular characteristics similar to
synthetic endocrine disruptors that could theoretically
disrupt hormones and promote cancer, however, this claim
has not been confirmed in human studies. In fact, soy may
have a real role in the prevention and treatment of breast
cancer.
Soy is a complete protein as it contains all the essential
amino acids including histidine. It is known to be low in
cysteine, which is required for infants, and therefore not
recommended for use in infancy. Food sources of soybeans
include soy milk and tofu. Fermented foods with soy are
natto and fermented bean paste. The form and type of soy
consumed should also be noted, as this has an impact on
absorption after consumption. For instance, it is known
that majority of the isoflavones in soy milk are glycosides,
but they are converted to aglycones by fermentation
(Takagi 2015). Isoflavone absorption is increased in
fermented soy milk beverage (in which the isoflavones are
largely converted to aglycones) in comparison to regular
soy milk. Some consideration should be given to the fact
that 93 per cent of soy is now a genetically modified
organism (GMO), and that it can cause allergic reactions
in some, however, further studies are needed to assess the
full effects of this (Kelly, 2015). Until this can be done, it is
best to use non-GMO soy and to avoid usage if allergic.
It should be noted that people metabolize soy phy-
toestrogens differently. Soy contains isoflavones, such as
genistein and daidzein. It also contains glycitein, an
O-methylated isoflavone that makes up 5–10% of the total
isoflavones in soy food (Song 1999). Equol is a gut bacterial
metabolite of the isoflavone daidzein, and has been asso-
ciated with beneficial health effects (Törmälä, 2007). Those
with the intestinal capacity to convert daidzein to equol
can change steroid metabolism and estrogen bioavailabil-
ity, and thus have an advantage using soy.
Red clover is a plant that has been used in traditional
medicine for centuries. It has phytoestrogens coumestrol
(CM) and formononetin (FM). It has been known for its use
in asthma, cholesterol reduction, hot flashes, indigestion
and cancer prevention. Recently, more research has been
done on the use of red clover in female conditions, including
menopause and cancer, alongside soy. The value of the
use of phytoestrogens (found in soy and red clover) to
combat cancer is now being assessed. For instance, one
source suggests a therapeutic dose of 40-50mg of isofla-
vones (biochanin A, daidzein, formononetin and genistein)
as daily dose for cancer prevention and additional health
benefits, and this is derived from the traditional Japanese
diet (Beck 2005).
IHP CoverStory.indd 39 2015-08-20 10:00 AM
SEPTEMBER 2015 • IHPMAGAZINE.COM 40
feature
MOLECULAR MECHANISMS OF SOY PHYTOESTROGENSSoy phytoestrogens are thought to be involved in breast
cancer prevention through certain mechanisms of action.
Genistein, for example, is believed to be involved in the
modulation of different signaling pathways associated with
the growth of cancer cells through pleiotropic actions includ-
ing inhibition of tyrosine kinases, DNA topoisomerase II,
5α-reductase, galectin-induced G2/M arrest, protein histidine
kinase, and cyclin-dependent kinases (Varinska 2015).
Another in vitro and in vivo study showed that genistein
reduced MCF-7 cell proliferation and induced the inactivation
of IGF-1R and p-Akt and downregulated the Bcl-2/Bax protein
ratio (Chen 2014). Overall, these mechanisms have shown
potential in breast cancer prevention.
MOLECULAR MECHANISMS OF RED CLOVER PHYTOESTROGENSMouse models and in vitro evidence have both shown inter-
esting ways in which red clover isoflavones, like formononetin
(FM) can be preventative in breast cancer. Cells treated with
FM have demonstrated reduced migration and invasion of
MDA-MB-231 and 4T1 cells in a wound healing assay, chamber
invasion assay, and an in vivo mouse metastasis model. In
vitro, FM inhibited breast cancer cell migration and invasion
by decreasing the expression of matrix metalloproteinase-2
(MMP-2), MMP-9 and increased the expression of tissue
inhibitor of metalloproteinase-1 (TIMP-1) and TIMP-2 (Zhou
2014). This finding, while preliminary, suggests that FM may
have anti-invasive properties for breast cancer, and that
red clover deserves further evaluation in this context.
Molecular evidence from Chen et al found that FM prevented
the proliferation of MCF-7 cells and arrested the cell cycle
in comparison to controls (Chen 2011). Levels of p-IGF-1R,
p-Akt, cyclin D1 protein expression, and cyclin D1mRNA
expression were also downregulated. FM also prevented
tumor growth of human breast cancer cells in nude mouse
xenografts in the same study. Overall, these results show
that FM halts the cell cycle at the G0/G1 phase by inactivating
IGF1/IGF1R-PI3K/Akt pathways, which demonstrate its poten-
tial in preventing breast cancer carcinogenesis (Chen 2011).
HUMAN STUDIES OF THE PROTECTIVE EFFECT OF RED CLOVER AND SOYThere are many epidemiological studies that support the
effects of soy and, a study for red clover, in either breast
cancer prevention or treatment alongside other therapies.
A recent systematic review suggested that soy food intake,
similar to a traditional Japanese diet (2-3 servings daily,
containing 25-50mg isoflavones) may be protective against
breast cancer and its recurrence (Fritz 2013). One study,
done on WHO-CARDIAC study populations, demonstrated
that the lower mortalities of breast cancers were inversely
related to the 24-h urinary isoflavone excretion (Yamori
2006). Another interesting, longitudinal, prospective study
of breast cancer patients in China noted that soy food intake
was safe and associated with a lower mortality and
recurrence of breast cancer in patients (Shu 2009). A meta-
analysis of breast cancer risk in Chinese women showed
that soy was a relevant factor in reducing the risk of breast
cancer development; significant differences were also found
between those who consumed soy foods, OR = 0.68 (95%
CI 0.50-0.93) and those who ate a high-fat diet, OR = 1.15
(95% CI 1.01-1.30) (Wu 2015). One study proposed that soy
should be used only in indicated patients and not in receptor
It should be noted that people metabolize soy phytoestrogens differently. Soy contains
iso�avones, such as genistein and daidzein.
IHP CoverStory.indd 40 2015-08-20 10:00 AM
SEPTEMBER 2015 • IHPMAGAZINE.COM 41
positive females. Woo et al. found that high intake of soy
isoflavones increased the risk of cancer recurrence in HER2-
positive breast cancer patients (Woo, 2012), however,
majority of the evidence proposes that soy is still protective.
Other convincing evidence comes from systematic
reviews and meta-analyses, such as the one by Liu et al.,
which concluded that consumption of both soy and fruit was
significantly associated with a decreased risk of breast
cancer, with summary ORs of 0.65 (95% CIs: 0.43-0.99;
I2=88.9%, P<0.001; N=13) and 0.66 (95% CIs: 0.47-0.91;
I2=76.7%, P<0.001; N=7), respectively (Liu 2014). A case control
study support this finding in Korean women; among soy
foods, a high intake of cooked soybeans, including yellow
and black soybeans, had an association with diminished
risk of breast cancer (OR=0.67; 95% CI=0.45-0.91; P<0.02)
(Do 2007). A case control German study showed that high
and low consumption of soybeans, as well as of sunflower
and pumpkin seeds were associated with significantly
reduced breast cancer risk compared to no consumption
(OR = 0.83, 95% CI = 0.70-0.97; and OR = 0.66, 95% CI =
0.77-0.97, respectively) (Zaineddin 2012).
Research on red clover is limited, however, it still gives
hope that could ease controversial claims that phytoestro-
gens, such as those found in red clover, may contribute to
breast cancer or recurrence. One systematic review suggests
that it may not promote breast cancer (Fritz 2013). Further
studies for red clover are required to support the dietary
use of phytoestrogens from this source and others.
CONCLUSIONOverall, molecular and human studies support the position
that soy based phytoestrogens do not promote nor cause
breast cancer; rather, studies have shown that soy may
decrease breast cancer risk, as well as protect against
recurrence. Red clover is thought to act via similar mecha-
nisms, however, requires further human study. For soy (pref-
erably non GMO), supplementation has been thought to be
more beneficial in equol producers. It has also been found
that breast cancer mortality was decreased in those with
increased excretion of phytoestrogen metabolites (i.e. in
the urine). There are some challenges in current research,
such as a need to bridge the findings of observational studies
to individual patient care (i.e. to address issues of intake
and heterogeneity), however, a start would be to utilize
doses with significant results in current studies and move
towards creating more structured, double-blind, placebo
controlled trials whenever possible (Ballard-Barbish, 2009).
A careful review of the evidence is required alongside a
specific tailored regimen for each case and patient. It is
important to consider the study population (Asian or other),
estrogen receptor status and the presence or absence of
menopause. Although interventional clinical trials are needed
to conclusively assess the role of soy and red clover, the
existing research suggests that red clover and soy may have
an important role to play in the prevention and treatment
of breast cancer when used in the right context.
View the references on your tablet.
IHP CoverStory.indd 41 2015-08-20 10:00 AM
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