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Soy

Also listed as: Soy isoflavones; Soy protein; Soybean

Overview
Therapeutic Uses
Dietary Sources
Dosage and Administration
 
Precautions
Interactions and Depletions
Supporting Research

Overview

People have been eating soybeans for almost 5,000 years. Unlike most plant foods, soybeans are high in protein. Today, researchers are interested in both the nutritional value and the potential health benefits of soy.

Several clinical studies of people who eat a lot of soy foods, such as people in Asia, suggest that soy may help reduce menopausal symptoms, and lower the risk of heart disease and osteoporosis. Researchers are also examining whether eating soy foods can help prevent hormone-related cancers, such as breast, prostate, and uterine cancer.

Isoflavones are phytoestrogens -- chemicals that act like the hormone estrogen. Soy phytoestrogens are very complex, and they can either strengthen or reduce the effects of estrogen in the body.

Soy contains other nutrients as well. Some researchers believe that the healthful benefits of soy foods may come from the combination of these nutrients and not just the isoflavones.

Therapeutic Uses

High Cholesterol

A number of studies suggest that soy protein may reduce the risk of heart disease by lowering levels of LDL "bad" cholesterol. For example, in a clinical study of nearly 5,000 men and women living in Japan, those who ate the most soy had the lowest cholesterol levels. Not all studies agree, but those that show benefits seem to indicate that soy protein may lower LDL up to 10% and total cholesterol up to 7%. A review of studies found that people with high cholesterol may reduce their total cholesterol by 9% if they eat 31 - 47 grams of soy protein instead of meat each day.

As a result, the U.S. Food and Drug Administration (FDA) in 1999 allowed soy products to carry a heart-healthy label saying that soy may reduce cholesterol when eaten as part of a diet that is low in saturated fat and cholesterol. In order for a particular food to carry this claim, one serving of the food must contain at least 6.25 grams of soy protein per serving. That is about 25% of the amount needed each day -- 25 grams of soy -- to get the heart-healthy benefit.

It is relatively easy to add enough soy to your daily diet to meet the 25 gram recommendation: 4 ounces of firm tofu contains 13 grams of soy protein; one soy "burger" includes 10 - 12 grams; and an 8-ounce glass of plain soy milk contains 10 grams.

The American Heart Association (AHA) also recommends adding at least 25 grams of soy protein per day to a diet low in saturated fat and cholesterol to reduce the risk of heart disease. Studies that offer evidence for this have found:

  • People in Asia who often eat soy foods, up to 55 grams of soy protein per day, have lower rates of heart disease than people who eat a typical Western diet, with fewer than 5 grams of soy protein per day.
  • Substituting 31 - 47 grams of soy protein for meat in a diet low in saturated fat and cholesterol may lower blood cholesterol levels.
  • Including at least 20 grams of soy protein per day in a diet low in saturated fat and cholesterol may reduce blood fat levels in both men and women, although not all studies agree.

Cancer

Evidence suggesting that soy may help prevent hormone-related cancers, such as breast, prostate, and uterine cancer, comes from population studies. These studies look at large numbers of people and have found that eating a diet high in soy protein may lower the risk of developing these kinds of cancers.

But the studies do not present a simple picture. For example, most studies that have found a lower risk of breast cancer have looked at Asian women, who typically eat a lot of soy. The studies that have looked at Western women have not all found a lower risk of breast cancer, although an analysis of 18 previously published studies found that in healthy women, soy was associated with a small (14%) reduction in breast cancer risk. Some studies suggest that a woman may get the best protection if she eats a diet high in soy when she is young, rather than when she goes through menopause.

The findings are also complicated when it comes to prostate cancer. Some studies suggest that the rates of prostate cancer are similar in Asian and Western countries, but more Western men than Asian men (who eat more soy) die from prostate cancer. But other studies show that men who eat a diet high in soy may have a lower risk of prostate cancer, although researchers aren't sure if that is because of what they eat. Other researchers note that as Japanese men age, their prostate size doesn't grow as much as it does in Western men, and think that a high soy diet may be the reason why.

Osteoporosis

Researchers have started to investigate whether soy foods can help prevent osteoporosis by increasing bone mineral density (BMD). Most of the research has focused on the isoflavones in soy protein. Although there aren't many studies, most suggest that women approaching menopause who eat isoflavone-rich soy protein are more likely to boost BMD than women whose diets are low in soy isoflavones. Some studies suggest that 80 - 90 mg of isoflavones in 40 g of soy protein worked the best.

However, other studies have found that soy isoflavones didn't increase bone mineral density in early postmenopausal women.

Menopause

Soy isoflavones may help reduce hot flashes and night sweats that many women have during menopause. In clinical studies, postmenopausal women who eat high amounts of dietary soy protein (20 - 60 g per day) generally have fewer and less intense hot flashes and night sweats than those who eat less soy.

Results of studies about whether soy supplements reduce menopausal symptoms have been mixed. In several studies, the women who took placebo also had fewer menopausal symptoms.

Some researchers also think that using soy extracts with different isoflavones in different studies can cause the results to be different. The studies with the most positive results have used soy products with at least 15 mg of genistein (an isoflavone) per day.

Dietary Sources

There are many soy foods. The whole soybean -- called edamame -- and tofu can be found in many Japanese and Chinese dishes and is growing popular in American cooking. Soft tofus are popular for shakes, salad dressings, and creamy dishes; firm tofus are easy to dice or crumble into stir fries or pasta.

Soy milk, soy cheese, soy yogurt, and soy nuts and nut butters can also be found at many grocery stores.

Other soy foods available in Western markets include miso, which is a mixture of fermented soybean paste and a grain such as rice or barley; natto, which are whole soybeans that have been cooked and fermented; and tempeh, made from a mixture of whole, cooked soybeans and grains cultured with an edible mold. Soy oil is a popular choice for cooking and frying oils and as a base for mayonnaise, salad dressing, and margarine.

In general, whole soybean-based foods, such as tofu and soy milk, have the highest protein and isoflavone content. The soy germ in whole soybeans is particularly high in isoflavones.

In addition to soy foods, dietary supplements containing one or more components from soy are also on the market. Researchers are studying one supplement, ipriflavone, to see if it may help strengthen bones.

Dosage and Administration

Pediatric

Soy foods and soy-based infant formula are conidered safe. But soy supplements are not recommended for children because there are no studies to say whether they are safe in children.

Adult

Heart Disease: Most studies have used between 20 - 80 grams of soy protein per day. Both the U.S. Food and Drug Administration and the American Heart Association (AHA) recommend 25 grams of soy protein as part of a diet that is low in cholesterol and saturated fat.

Cancer: Phytoestrogens in dietary soy may help prevent hormone-related cancers, such as breast, endometrial, and prostate cancer. But there are no details about dosage, frequency of use, or safety. Studies have examined soy foods, not soy supplements.Some researchers suggest that soy foods, not soy supplements, should be part of a healthy diet for preventing cancer. If you are being treated for cancer, talk to your doctor about the possible risks and benefits of eating soy foods. (See "Precautions.") Do not take soy supplements without your doctor's supervision.

Menopause: According to the North American Menopause Society, eating whole foods containing the following amounts of isoflavones may have health benefits for postmenopausal women:

  • 50 mg daily to reduce cholesterol
  • 40 - 80 mg daily to strengthen blood vessels and possibly improve blood pressure
  • 50 mg daily for bone health
  • 40 - 80 mg daily to reduce hot flashes

Some experts believe that it is still too early to recommend soy isoflavones for the treatment of menopausal symptoms. There isn't specific information about the right dose, how long to take it, and what the long-term effects of phytoestrogens may be.

Precautions

Soy Allergy

People who are allergic to soy should avoid soy foods and any supplements containing soy components, such as soy isoflavones.

Breast Cancer

Findings from laboratory studies have raised concerns that soy consumption may stimulate the growth of breast cancer cells. So while researchers believe soy reduces the risk of breast cancer, it might not be safe for women who have already had breast cancer. More research is needed to settle the issue.

Soy supplments may make the breast cancer medication tamoxifen (Nolvadex) less effective. Women taking tamoxifen shouldn't take soy supplements.

Kidney Disease

Soy has more phosphorus and potassium than similar amounts of meat, poultry, or fish. People with kidney disease should talk to their nephrologist (kidney specialist) or renal dietitian before eating soy foods.

Hypothyroidism

Isoflavones may lower the amount of iodine in the body, which can lead to underfunctioning of the thyroid, called hypothyroidism. A few cases of hypothyroidism have been reported in infants fed soy formula. It's rare in the United States where most people use iodized salt.

Uterine Cancer

Women with uterine (endometrial) cancer should not take soy supplements without first asking their doctor.

Side Effects

For people who are not allergic to soy, no serious short-term or long-term side effects have been reported from eating soy foods. Common mild side effects include stomach upset and digestive problems, such as constipation and diarrhea.

Pregnancy and Breastfeeding

Eating soy foods during pregnancy and while breastfeeding is considered safe. Women who are pregnant or breastfeeding should not take soy supplements without asking their doctor.

Pediatric Use

Since phytoestrogens may affect certain hormones in the body, there has been some concern that infant soy formulas could cause reproductive or health problems later on. However, clinical studies of infants fed either soy formula or cow's milk formula found no differences between the two groups.

Interactions and Depletions

The phytoestrogens in soy may interfere with the drug tamoxifen (Nolvadex), used in breast cancer treatment, and the drug raloxifene (Evista), used to prevent and treat osteoporosis. The minerals zinc and iron may also interfere with the absorption of soy and could lower soy levels in the body.

Soy may increase the risk of bleeding, especially if you also take blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.

People who take antidepressants called MAOIs, such as phenelzine (Nardil) and tranylcypromine (Parnate), should not eat soy foods or take soy supplements.

Supporting Research

Alekel DL, Germain AS, Peterson CT, Hanson KB, Stewart JW, Toda T. Isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women. Am J Clin Nutr. 2000;72(3):844-852.

Alekel DL, Van Loan MD, Koehler KJ, Hanson LN, Stewart JW, Hanson KB, Kurzer MS, Peterson CT. The Soy Isoflavones for Reducing Bone Loss (SIRBL) Study: a 3-y randomized controlled trial in postmenopausal women. Am J Clin Nutr. 2009 Nov 11. [Epub ahead of print]

Azadbakht L, Kimiagar M, Mehrabi Y, Esmaillzadeh A, Hu FB, Willett WC. Soy consumption, markers of inflammation, and endothelial function: a cross-over study in postmenopausal women with the metabolic syndrome. Diabetes Care. 2007;30(4):967-73.

Effects of the phytoestrogen genistein on some predictors of cardiovascular risk in osteopenic, postmenopausal women: a two-year randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2007 Aug;92(8):3068-75. Epub 2007 May 22.

Constantinou AI, Xu H, Cunningham E, Lantvit DD, Pezzuto JM. Consumption of soy products may enhance the breast cancer-preventive effects of tamoxifen. Paper presented at: American Association of Cancer Research 92nd Annual Meeting; March 24-28, 2001; New Orleans, La.

Erdman JW Jr. AHA Science Advisory: Soy protein and cardiovascular disease: a statement for healthcare professionals from the Nutrition Committee of the AHA. Circulation. 2000;102(20):2555-2559.

Gallagher JC, Satpathy R, Rafferty K, Haynatzka V. The effect of soy protein isolate on bone metabolism. Menopause 2004; 11(3):290-298.

Germain AS, Peterson CT, Robinson JG, Alekel DL. Isoflavone-rich or isoflavone-poor soy protein does not reduce menopausal symptoms during 24 weeks of treatment. Menopause. 2001;8(1):17-26.

Glazier MG, Bowman MA. A review of the evidence for the use of phytoestrogens as a replacement for traditional estrogen replacement therapy. Arch Intern Med. 2001;161(9):1161-1172.

Hermansen K, Sondergaard M, Hoie L, Carstensen M, Brock B. Beneficial effects of a soy-based dietary supplement on lipid levels and cardiovascular risk markers in type 2 diabetic subjects. Diabetes Care. 2001;24(2):228-233.

Hoie LH, Guldstrand M, Sjoholm A, et al. Cholesterol-lowering effects of a new isolated soy protein with high levels of nondenaturated protein in hypercholesterolemic patients. Adv Ther. 2007;24(2):439-47.

Hwang YW, Kim SY, Jee SH, Kim YN, Nam CM. Soy food consumption and risk of prostate cancer: a meta-analysis of observational studies. Nutr Cancer. 2009;61(5):598-606.

Liao FH, Shieh MJ, Yang SC, Lin SH, Chien YW. Effectiveness of a soy-based compared with a traditional low-calorie diet on weight loss and lipid levels in overweight adults. Nutrition. 2007;23(7-8):551-6.

Messina M, Messina V. Soyfoods, soybean isoflavones and bone health: a brief overview. J Ren Nutr. 2000;10(2):63-68.

Nagata C. Ecological study of the association between soy product intake and mortality from cancer and heart disease in Japan. Int J Epidemiol. 2000;29(5):832-836.

Nagata C, Takatsuka N, Kawakami N, Shimizu H. Soy product intake and hot flashes in Japanese women: results from a community-based prospective study. Am J Epidemiol. 2001;153(8):790-793.

Nahas EA, Nahas-Neto J, Orsatti FL, et al. Efficacy and safety of a soy isoflavone extract in postmenopausal women: A randomized, double-blind, and placebo-controlled study. Maturitas. 2007; [Epub ahead of print].

North American Menopause Society. The role of isoflavones in menopausal health: consensus opinion of the North American Menopause Society. Menopause. 2000;7(4):215-229.

Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006;(4):CD003741.

Perabo FG, Von Low EC, Ellinger J, von Rucker A, Muller SC, Bastian PJ. Soy isoflavone genistein in prevention and treatment of prostate cancer. Prostate Cancer Prostatic Dis. 2007; [Epub ahead of print].

Quella SK, Loprinzi CL, Barton DL, et al. Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: a North Central Cancer Treatment Group trial. J Clin Oncol. 2000;18(5):1068-1074.

Reynolds K, Chin A, Lees KA, Nguyen A, Bujnowski D, He J. A meta-analysis of the effect of soy protein supplementation on serum lipids. Am J Cardiol. 2006;98(5):633-40.

Shu XO, Zheng Y, Cai H, Gu K, Chen Z, Zheng W, Lu W. Soy food intake and breast cancer survival. JAMA. 2009 Dec 9;302(22):2437-43.

Somekawa Y, Chiguchi M, Ishibashi T, Aso T. Soy intake related to menopausal symptoms, serum lipids and bone mineral density in postmenopausal Japanese women. Obstet Gynecol. 2001;97(1):109-115.

Strom BL, Schinnar R, Ziegler EE, et al. Exposure to soy-based formula in infancy and endocrinological and reproductive outcomes in young adulthood. JAMA. 2001;286(7):807-814.

Teixeira SR, Potter SM, Weigel R, Hannum S, Erdman JW Jr, Hasler CM. Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood lipids and apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr. 2000;71(5):1077-1084.

This P, De La Rochefordiere A, Clough K, Fourquet A, Magdelenat H; The Breast Cancer Group of the Institut Curie. Phytoestrogens after breast cancer. Endocr Relat Cancer. 2001;8(2):129-134.

Trock BJ, Hilakivi-Clarke L, Clarke R. Meta-analysis of soy intake and breast cancer risk. J Natl Cancer Inst. 2006;98:459-71.

Trottier G, Boström PJ, Lawrentschuk N, Fleshner NE. Nutraceuticals and prostate cancer prevention: a current review. Nat Rev Urol. 2009 Dec 8. [Epub ahead of print]

Unfer V, Casini ML, Costabile L, et al. Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study. Fertil Steril. 2004;82:145-8.

Upmalis DH, Lobo R, Bradley L, Warren M, Cone FL, Lamia CA. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause. 2000;7(4):236-242.

Velasquez MT, Bhathena SJ. Role of dietary soy protein in obesity. Int J Med Sci. 2007;4(2):72-82.

Vincent A, Fitzpatrick LA. Soy isoflavones: are they useful in menopause? Mayo Clin Proc. 2000;75(11):1174-1184.

Wong WW, Lewis RD, Steinberg FM, Murray MJ, Cramer MA, Amato P, Young RL, Barnes S, Ellis KJ, Shypailo RJ, Fraley JK, Konzelmann KL, Fischer JG, Smith EO. Soy isoflavone supplementation and bone mineral density in menopausal women: a 2-y multicenter clinical trial. Am J Clin Nutr. 2009 Nov;90(5):1433-9.


Review Date: 1/15/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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