Maintaining and restoring intestinal microflora can augment the effects of isoflavone consumption. The DIANA study suggested that the bioavailability of phytoestrogens may have been higher as a result of the enhanced microflora balance produced by a more vegetarian diet that promoted beneficial flora growth. Phytoestrogens are in foods, in the form of glycosides that must be hydrolyzed by gut bacteria to produce aglycones. Studies comparing Western microflora versus the flora of vegetarians or people who consume macrobiotic diets demonstrate that the latter subjects typically have more lactobacilli and bifidobacteria, which hy-drolyzes glycosides to aglycones.41 Thus, diets emphasizing plant foods are recommended. Probiotics, themselves, have not been shown to directly affect phytoestrogen metabolism, although they can decrease beta-glucuronidase activity.

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