Changes in diet reduce hot flashes by 84% without drugs
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Women who are experiencing hot flashes as part of menopause could benefit from changes in their diet without additional medication, according to the Physicians Committee for Responsible Medicine.
The nonprofit’s researchers report that a plant-based diet rich in soy reduces moderate to severe hot flashes by nearly 84%, from nearly five per day to fewer than one. Also, 59% of women became totally free of moderate to severe hot flashes, and overall hot flashes — including mild ones — decreased by 79% during the study.
The researchers said these results show that dietary changes can be much more powerful for treating hot flashes and other vasomotor symptoms, including night sweats and flushes, than previously thought.
No hormone medications or extracts were involved in the study. The researchers instead used a low-fat, plant-based diet with half a cup of soybeans added to a soup or salad each day.
“This is a game changer for women aged 45 and over, most of whom we now know can get prompt relief from the most severe and troubling menopause symptoms without drugs,” researcher Neal D. Barnard, MD, FACC, president of the Physicians Committee for Responsible Medicine (PCRM) and adjunct professor at the George Washington University School of Medicine and Health Sciences, said in a press release.
As many as 80% of postmenopausal women experience hot flashes, the PCRM said. Although estrogen-based medications at one point were used to treat hot flashes, they since have been shown to increase the risk for breast cancer and other problems. Also, PCRM said that isoflavone extracts have modest effects, leaving women with few treatment options.
In the WAVS trial — the Women's Study for the Alleviation of Vasomotor Symptoms — Barnard and colleagues randomly assigned 38 women who experienced two or more hot flashes a day to an intervention group or a control group. The intervention group began a low-fat vegan diet including half a cup (86g) of cooked soybeans daily for 12 weeks. The control group had no changes in their diet. Seventeen women remained in each group through the end of the study period.
The women recorded the frequency and severity of their hot flashes via a mobile application. Also, the researchers assessed vasomotor, psychosocial, physical and sexual symptoms with the Menopause-Specific Quality of Life (MENQOL) questionnaire.
Each woman received a digital self-calibrating scale to track their body weight each day and an Instant Pot to prepare their soybeans as well. The group met with the researchers via Zoom each week.
“Previous studies have shown that soy could be beneficial, so we decided to put a diet change to the test,” author Hana Kahleova, MD, PhD, PCRM director of clinical research, said in the release.
“We believe that the combination is what is important. By the end of the study, the majority of women on a plant-based diet rich in soy reported that they no longer experienced moderate to extreme hot flashes at all and that they experienced significant improvements in their quality of life,” Kahleova said.
The women in the control group saw no changes in their hot flashes, the researchers said.
Previous randomized trials have shown that soy products can modestly reduce hot flash frequencies. Soy products include isoflavones, which gut bacteria can metabolize into equol, a nonsteroidal compound shown to reduce the incidence and severity of hot flashes in some studies, the researchers noted.
People who follow vegetarian or vegan diets also produce higher levels of equol, according to previous studies. The researchers noted that their study showed a more robust response with the combination of a plant-based diet and soy.
Additionally, many of the women in the study reported improved sexual symptoms, mood, and overall energy, the researchers said. Several participants noticed significant weight loss and better digestion as well.
Reference:
Barnard ND, et al. Menopause. 2021;doi:10.1097/GME.0000000000001812.
Perspective
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Mary Jane Minkin, MD
For many years, it has been thought that soy products can help with hot flashes. The rationale has been that soy contains isoflavones, which are weak plant estrogens. There have been some studies in the past showing that women placed on higher soy diets did have fewer hot flashes. And Japanese women, who have the highest soy intake in the world, do seem to suffer from fewer vasomotor symptoms.
In this protocol, women who had at least two moderate to severe hot flashes daily were studied. These women were not on medications and were on average in their early to mid-50s.
In this study, women were randomly assigned into two groups, one of which was instructed regularly to eat a vegan diet with soybeans, and the other a control group. Both groups were evaluated after 12 weeks. Indeed, the women on the vegan diet with soy supplementation did show a significant reduction in hot flashes.
What is the significance of these data? The major concern with extrapolation of these data is that the study was very small. Each group studied had 17 women in it. Also, in general, studies looking at women with moderate to severe hot flashes look at women who have a minimum of seven flashes daily, or 50 weekly.
Does it make sense for women to try this type of intervention? I think it is totally reasonable. A low-fat vegan diet with the addition of soybeans is helpful for most everything. Women in this study on this diet lost an average of 3.5 kg, whereas women in the control group gained almost 1 kg. We do know that women who are obese are much more likely to suffer hot flashes, so that weight loss is clearly advantageous. It also should help lipid profiles.
One group of women particularly should speak with their providers before instituting such a dietary change. For many years, some breast oncologists have expressed concern for soy supplementation because of soy’s weak plant estrogenic activity. Many oncologists, however, believe that soy acts more like tamoxifen, blocking stronger estrogenic activity at the breast. So, I always ask my breast cancer patients to check in with their oncologists before switching to a high-soy plan.
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