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Neal Barnard, M.D.

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Settling The Soy Controversy

Posted: 02/24/10 03:46 PM ET

Soy products are remarkably versatile. Manufacturers have found ways to turn them into soymilk, veggie burgers, hot dogs, ice cream, yogurt--you name it. One day, they'll probably turn soy into snow tires.

Because soy products are so widely consumed, some people have raised the question as to whether they are safe. The biggest question mark was whether they affect the risk of breast cancer and, for women who have been diagnosed with breast cancer, whether they would help or harm their chances for survival.

After years of research, science is weighing in. Here is what the studies show:

Cancer Prevention and Survival

Women who include soy products in their routines are less likely to develop breast cancer, compared with other women. In January 2008, researchers at the University of Southern California found that women averaging one cup of soymilk or about one-half cup of tofu daily have about a 30 percent less risk of developing breast cancer, compared with women who have little or no soy products in their diets (1). However, to be effective, the soy consumption may have to occur early in life, as breast tissue is forming during adolescence (2-3).

What about women who have already been diagnosed with breast cancer? A study published in the Journal of the American Medical Association in 2009 shows that soy products may reduce the risk of recurrence (4). In a group of 5,042 women previously diagnosed with breast cancer who were participating in the Shanghai Breast Cancer Survival Study over a four-year period, those who regularly consumed soy products, such as soymilk, tofu, or edamame, had a 32 percent lower risk of recurrence and a 29 percent decreased risk of death, compared with women who consumed little or no soy. An accompanying editorial suggested that inconsistencies in prior research may be attributable to the comparatively low soy consumption in the United States, making beneficial effects harder to identify (5).

Why should soy products reduce cancer risk? Most research has zeroed in on phytoestrogens found in soybeans (phyto means "plant"). These compounds are in some ways similar to the estrogens (female sex hormones) in a woman's bloodstream, but are much weaker. Some have suggested that phytoestrogens attach to the estrogen receptors in a woman's body, blocking her natural estrogens from being able to attach and stopping estrogen's cancer-inducing effects.

By analogy, the estrogens in a woman's body are like jumbo jets that have landed at an airport. Phytoestrogens are like small private planes that are occupying the Jetways, blocking the jumbo jets from attaching. This explanation is probably overly simplistic, but it may serve to illustrate how soy's weak hormonal compounds can have beneficial effects.

Fibroids

Soy products may reduce the risk of fibroids, knots of muscle tissue that form within the thin muscle layer that lies beneath the uterine lining. A study of Japanese women found that the more soy women ate, the less likely they were to need a hysterectomy, suggesting that fibroids were less frequent (6). In a study of women in Washington State, soy did not seem to help or hurt, perhaps because American women eat very little soy, compared with their Japanese counterparts (7). What did have a big effect in this study were lignans, a type of phytoestrogens found in flaxseed and whole grains. The women consuming the highest amounts of these foods has less than half the risk of fibroids, compared with the women who generally skipped these foods. So, again, phytoestrogens seem beneficial, countering the effects of a woman's natural estrogens, although in this case the benefit comes from foods other than soy.

Soy and Male Hormones

How about men? Although compounds in soy products have been likened to very weak female hormones, they have no adverse effects on men and may actually help them prevent cancer. A meta-analysis to be published in Fertility and Sterility, based on more than 50 treatment groups, showed that neither soy foods nor isoflavone supplements from soy affect testosterone levels in men (8). An analysis of 14 studies, published in the American Journal of Clinical Nutrition showed that increased intake of soy resulted in a 26 percent reduction in prostate cancer risk (9). Researchers found a 30 percent risk reduction with nonfermented soy products such as soy milk and tofu.

Thyroid Health

Clinical studies show that soy products do not cause hypothyroidism (10). However,
soy isoflavones may take up some of the iodine that the body would normally use to make thyroid hormone (11). The same is true of fiber supplements and some medications. In theory, then, people who consume soy might need slightly more iodine in their diets (iodine is found in many plant foods, and especially in seaweed and iodized salt.) Also, a note for people with hypothyroidism: Soy products may reduce the absorption of medicines used to treat the condition (10). People who use these medicines should check with their healthcare providers to see if their doses need to be adjusted.

Other Health Effects

Soy products appear to reduce low density lipoprotein ("bad") cholesterol (12). They may also reduce the risk of osteoporosis-related hip fractures. In a study published in the American Journal of Epidemiology, women who consumed at least one-fourth cup of tofu per day averaged a 30 percent reduction in fracture risk (13).

Protein: A Little Goes a Long Way

Many soy products are high in protein. Manufacturers have exploited this fact, packing isolated soy protein into shakes and turning it into meat substitutes. But some have raised the concern that pushing protein intake too high--from any source--might not be wise. The concern is that an overly high protein intake may boost the amount of insulin-like growth factor (IGF-I) in the bloodstream (14), a phenomenon known to occur with cow's milk (15). High IGF-I levels are linked to higher cancer risk. Some reassurance comes from the fact that soy intake is linked to lower, not higher, cancer risk, and simple soy products, such as tempeh, edamame, or soynuts, are unlikely to affect IGF-I levels, in any case.

In summary, evidence to date is reassuring. Soy products may reduce the risk of breast cancer and breast cancer recurrence. They do not appear to have adverse effects on male hormone function or on the thyroid gland, but may reduce the absorption of thyroid medications.

Having said that, soy products are certainly not essential. Many people who start a healthful vegan diet, as I and many other doctors recommend, seem to feel they must have soy products. But the fact is, a vegan diet can follow a Mediterranean tradition, focusing on vegetables, fruits, beans and pasta. Or it might follow a Latin American tradition of beans, rice, and corn tortillas. Soy products come from an Asian tradition with many healthful delights and the most enviable health statistics on record. So soy is handy, but it is certainly not essential. If you choose to include soy products in your routine, you'll have science on your side.

References

1. Wu AH, Yu MC, Tseng CC, Pike MC. Epidemiology of soy exposures and breast cancer risk. Br J Cancer 2008;98:9-14.

2. Korde LA, Wu AH, Fears T, et al. Childhood soy intake and breast cancer risk in Asian American women. Cancer Epidemiol Biomarkers Prev 2009;18:OF1-10.

3. Shu XO, Jin F, Dai Q, et al. Soyfood intake during adolescence and subsequent risk of breast cancer among Chinese women. Cancer Epidemiol Biomarkers Prev. 2001;10:483-8.

4. Shu XO, Zheng Y, Cai H, et al. Soy food intake and breast cancer survival. JAMA. 2009;302:2437-2443.

5. Ballard-Barbash R, Neuhouser ML. Challenges in design and interpretation of observational research on health behaviors and cancer survival. JAMA. 2009;302:2483-2484.

6. Nagata C, Takatsuka N, Kawakami N, Shimizu H. Soy product intake and premenopausal hysterectomy in a follow-up study of Japanese women. Eur J Clin Nutr 2001:55:773-7.

7. Atkinson C, Lampe JW, Scholes D, Chen C, Wahala K, Schwartz SM. Lignan and isoflavone excretion in relation to uterine fibroids: a case-control study of young to middle-age women in the United States. Am J Clin Nutr 2006:84:587-93.

8. Hamilton-Reeves JM, Vazquez G, Duval SJ, Phipps WR, Kurzer MS, Messina MJ. Clinical studies show no effects of soy protein or isoflavones on reproductive hormones in men: results of a meta-analysis. Fertil Steril. June 11, 2009. DOI:10.1016/j.fertnstert.2009.04.038.

9. Yan L, Spitznagel EL. Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis. Am J Clin Nutr. 2009;89:1155-1163.

10. Messina M, Redmond G. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid 2006;16:249-58.

11. Divi RL, Chang HC, Doerge DR. Anti-thyroid isoflavones from soybean: isolation, characterization, and mechanisms of action. Biochem Pharmacol 1997;54:1087-96.

12. Pipe EA, Gobert CP, Capes SE, Darlington GA, Lampe JW, Duncan AM. Soy protein reduces serum LDL cholesterol and the LDL cholesterol:HDL cholesterol and apolipprotein B:apolipprotein A-1 ratios in adults with type 2 diabetes. J Nutr. 2009;139:1700-1706.

13. Koh WP, Wu AH, Wang R, et al. Gender-specific associations between soy and risk of hip fracture in the Singapore Chinese Health Study. Am J Epidemiol. 2009;170:901-909.

14. Dewell A, Weidner G, Sumner MD, et al. Relationship of dietary protein and soy isoflavones to serum IGF-1 and IGF binding proteins in the Prostate Cancer Lifestyle Trial. Nutr Cancer 2007;58:35-42.

15. Heaney RP, McCarron DA, Dawson-Hughes B, et al. Dietary changes favorably affect bone remodeling in older adults. J Am Dietetic Asso 1999;99:1228-33.

 
Soy products are remarkably versatile. Manufacturers have found ways to turn them into soymilk, veggie burgers, hot dogs, ice cream, yogurt--you name it. One day, they'll probably turn soy into snow t...
Soy products are remarkably versatile. Manufacturers have found ways to turn them into soymilk, veggie burgers, hot dogs, ice cream, yogurt--you name it. One day, they'll probably turn soy into snow t...
 
 
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01:23 PM on 03/05/2010
Unfortunately for me, soy gives me huge hot flashes that sometimes last more than an hour. Soy items must be off my plate now.
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Beth Boyle
12:16 AM on 03/02/2010
Yeah they told us corn syrup was OK too. I am not eating unfermented soy, sorry. I won't feed soy to my livestock either. I will stick with black beans and rice thanks!
05:34 PM on 03/01/2010
A lot of what readers are saying here is brainwashing from the Weston Price Foundation, which is headed by a woman with no health degree at all and was started by a group of cattle ranchers for lobbying and propoganda purposes.

All of the research by the meat and dairy industry say their products are healthy (a lot of it is done at major universiies too but funded by lobbyists) and all of the research that is not funded by the meat and dairy industry say their products are devastating health wise.

Our universities get funded by the beef and dairy industries to do research and if you look closely you will see that no one ever got healthy following the guidelines that come out of that research. These industry funded studies are primarily meant to confuse the public and medical doctors too.

Dr Barnard on the other hand, along with many vegan diet doctors, from Esselstyn and Ornish, to McDougall and Fuhrman, have reversed serious medical conditions for decades now.

Please get it. Sally Fallon is nothing but a propagandist for the meat and dairy industries. Along with all the board members there who continually try to scare, confuse, and misinform consumers - Mercola, Enig, and Daniel. They are very organized and have confused a lot of people.

The New Zealand group has connections to Sally's husband, who was a cattle rancher in New Zealand. They want you to buy beef and not tofu.
11:11 PM on 03/02/2010
See http://www.westonaprice.org/Board-of-Directors.html , which lists Sally Fallon Morell and Geoffrey Morell, the latter described as (in part): "a practicing naturopath, specializing in the past 20 years in the field commonly called magnetic, intuitive, spiritual or psychic healing. He has developed his own unique Clendinning Technique. He had a grass-based dairy farm in New Zealand for over 30 years."

Richard F. James and Valerie A. James, are listed as the operators of http://soyonlineservice.co.nz. There's no guarantee of balance in such sites - and their list of abstracts seems not to go past 2005 - but I don't think the arguments against soy should be dismissed due to any critique of people who run such a website. They didn't write the 100+ peer-reviewed papers whose abstracts appear at: http://www.soyonlineservice.co.nz/07abstract.htm .

Take a look at the data table (Daidzein, Genistein, Glycitein and total Isoflavones) at http://www.nal.usda.gov/fnic/foodcomp/Data/isoflav/isoflav.html (USDA-Iowa State University Database on the Isoflavone Content of Foods, Release 1.3 - 2002) - soy products have very much higher levels than other foods tested. Flaxseed (linseed) is another strong and widely ingested source of phytoestrogens.

See http://e.hormone.tulane.edu/learning/phytoestrogens.html which considers both benefits and problems, including reproductive problems, allergies and "hypospadias (a birth defect in boys where the penis opening is not located in the normal position at the tip of the penis)".
07:59 PM on 02/28/2010
Umm.....this is written by a soy lobbyist. Check this out: http://activistcash.com/organization_overview.cfm/o/23-physicians-committee-for-responsible-medicine

Often appearing in a lab coat, PCRM president Neal Barnard looks the part of a mainstream health expert. He also churns out a steady stream of reliably anti-meat and anti-dairy nutrition research. Although his “results” generally conclude that a vegan diet (practiced by a tiny fraction of Americans) will solve any of dozens of health problems, the mass media eats them up. And PCRM is media-savvy enough to take advantage.

But Barnard was trained as a psychiatrist, not a nutritionist. His nutritional advice boils down to one basic message: don’t eat meat, or anything that comes from animals. PCRM has complained to the Federal Trade Commission about advertisements that depict milk as part of a healthy diet. It petitioned the government to slap meat and poultry with a “biohazard label,” adding in its newsletter that eggs should carry these dire warnings as well"

Follow the money.
06:19 PM on 03/01/2010
Doesn't surprise me one bit. Thanks for the heads up.
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Bytown
One way or the other!!
11:55 AM on 02/28/2010
There's nothing settled when you use words like" it MAY" do something.
01:09 PM on 02/28/2010
Did you notice you used past tense and the article used present tense AND do you know the difference?
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Bytown
One way or the other!!
10:13 PM on 02/28/2010
"However, to be effective, the soy consumption MAY have to occur early in life,"

"MAY help them prevent cancer"...

I seem to see a lot of "may"s in this article.
03:09 AM on 02/28/2010
It makes no sense to claim to have settled a controversy such as this on the basis of just 15 journal articles.

http://www.soyonlineservice.co.nz is a good source of well-referenced material which is critical of soy food. If even a fraction of the concerns raised in the research listed there are realistic then modern industrial soy foods are best avoided without careful investigation.

http://pubmed.gov finds 9951 articles concerning soy. Looking at the abstract of a single one: "Factors to Consider in the Association Between Soy Isoflavone Intake and Breast Cancer Risk" Chisato Nagata, Journal of Epidemiology (Japan) 2010-02-20 (http://www.jstage.jst.go.jp/article/jea/advpub/0/1002160133/_pdf) shows how complex the issues are.
12:58 PM on 02/28/2010
You are right in that nothing is really absolute. However looking at the data of non gmo soy even non fermented is exceedingly healthier than 90% of meat available which is injected full of hormones and antibiotics, right?
04:00 PM on 02/27/2010
Any soy product is processed...starting with the seed that has been genetically engineered by Monsanto which has a monopoly in soy.
08:10 PM on 02/27/2010
Is it possible that Dr. Barnard could be on Monsanto's payroll? Unfermented soy, is extremely unhealthy and my M.D. told me to stop consuming it years ago.
02:41 AM on 02/28/2010
I am wondering the same thing. I am all for vegetarianism and veganism, but when one fails to mention the very real risks of eating non-fermented GMO soy it raises a lot of questions for me. Also, I think it's important to state within an article like this the history of soy in Asia: the fact that it is used primarily as a rotational crop and the fact that it is consumed in small, fermented quantities - so unlike what is happening here in the West.
12:26 PM on 02/28/2010
Why is it unhealthy? Your doctor is speaking for the whole planet and you can't be bothered to show a single piece of evidence?
12:24 PM on 02/28/2010
What are you talking about and where did you get this info? Really?

How can you be posting in a forum about soy and say it's all gmo, pretending you know what your talking about are you from fakenews?

A 4 year with google could put you down.

You must be intentionally trying to mislead people.
01:50 PM on 02/27/2010
I attended a lecture by Dr. Barnard. He believes in a very low fat diet and promotes veganism, I believe out of sympathy for animals. People are free to be vegans for this reason but the science does not support this as the healthiest way to eat.

Dr. Barnard commits the sin of equating causality with association. The studies he cites are mostly epidemiological and may show that eating soy is associated with better health. Because of the nature of these studies you cannot conclude that eating soy caused the health outcome. From these types of data it would be equally possible to conclude that people eat more soy because they are healthier to begin with. It is possible that people who eat soy do other things that impact on their health. The only way to figure this out is to do a long-term dietary trial where the only difference between two random groups is the level of soy consumption. This would be difficult, time-consuming and expensive. This is a common problem in nutritional research and why we so often see people drawing causality conclusions from associations.

In the presentation I attended, I was surprised to hear Dr. Barnard, in promoting a very low fat diet, advise against eating olive oil since olive oil and other fat sources such as pork and dairy are a big part of the Mediterranean diet and one of the reasons why it is a very healthy way of eating.
11:43 PM on 02/27/2010
Absolutely. There are good studies that found vegetarians have worse general health than the omnivorous population. Assuming this is true, the question is why? Perhaps the diet really is inadequate. Or it may be that a fair number of vegetarians are too lazy to learn how to devise a diet that meets their nutritional needs. Then again, it may be that a significant percentage of the vegetarians in these studies didn't adopt the diet until after their health began to fail. The answer may even be all of the above.
12:39 PM on 02/28/2010
What science says vegetarianism isn't the healthiest way to eat, how is this even possible the very human digestive system is scientifically proven to be designed for fruits, vegetables and nuts? Can it digest meat? Duh. Is the majority of meat at least here in the US injected full of hormones and antibiotics (we are talking 90% + here people)? ELL yes. Yet you don't even bother to mention this in your conclusion or even in your consideration of the facts? WT*?

No long term studies are you joking, Asia was eating non gmo soy for decades if not more, how the hell is that not a long term study?

Speaking of "people drawing causality conclusions from associations" did you actually read your post?

It' almost as if your from the meat industry, trying to cast disperstions on the non gmo soy industry through fear without actual facts?

You know standard fakenews practices of *Reporting allegation as fact*.
02:53 PM on 02/28/2010
It’s almost as if you’re from the vegan/vegetarian brigade set to cast the big bad meat eaters/soy haters to death. First, we are not meant to eat the exact same way. Some are meant to eat more protein and some are to eat more carbohydrates. ‘The Metabolic Typing Diet” by Wolcott and Fahey is a good read. Second, comparing “non-gmo” soy to “antibiotic filled” meat is an unfair comparison…oh wait you know what those cows are probably eating: corn and soy amongst other things cows aren’t supposed to be consuming. Them eating those grains, gmo or not, are making their bodies less acidic which means a more likelihood to develop more e-coli bacteria, thusly, more antibiotics. So, yeah it’s not the healthiest thing to eat. As for eating “non-gmo” soy that is fermented I have no problem but non-fermented, no thanks. It inhibits absorption of certain minerals and affects the thyroid.
I’ll take grass-fed meat over “non-gmo” soy any flippin’ day of the week.
http://foodincmovie.com/
http://www.amazon.com/dp/0967089751/ref=nosim/?tag=shirlswellncafen
01:02 PM on 02/27/2010
It's interesting to note that bodybuilding consumers frequently avoid soy-based protein supplements like the plague, principally for two reasons:

(1) Soy is considered inferior to animal proteins such as whey (derived from cow's milk) for the purposes of stimulating muscle protein synthesis (the essential element of building muscle).

(2) Fear of possible estrogenic effects, including antagonism of the muscle-building effects of testosterone.

The commenter above makes a good point about meta-analyses. One of their shortcomings is they tend to lump together "bad" and "good" studies so that the average outcome, or effect size, is brought down.

That being said, Goodin et al. (2007) reported a 19% drop in testosterone in young males (25-47) who consumed a soy protein powder every day for 28 days. Testosterone levels rebounded after discontinuing the soy protein supplement for 2 weeks.

The authors of the meta-analysis Dr. Barnard refers to (Hamilton-Reeves et al. 2009) note, however, that Goodin et al.'s results may stem largely from a single "outlier". You can read their comments here:
http://cebp.aacrjournals.org/content/16/12/2795.long

For what it's worth, I consumed copious amounts of soy (protein powders, tofu, milk) for years and never experienced undesirable effects on body composition. I suspect soy is unlikely to undermine one's bodybuilding efforts and will not harm healthy adult males. Whether or not it exerts negative effects when consumed earlier in life (e.g. soy infant formulas) remains to be determined.
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12:09 PM on 03/01/2010
The bodybuilders I know are more superstitious than a pro baseball player, and avoid soy because all the guys in the gym say to, not because they have actually done the research. Anything that might affect their boy parts from shrinking any more, as the steroids are already shrinking them enough.

"Lift like a girl"
12:36 PM on 02/27/2010
Myths & Truths About Soy

Myth: Use of soy as a food dates back many thousands of years.

Truth: Soy was first used as a food during the late Chou dynasty (1134-246 BC), only after the Chinese learned to ferment soy beans to make foods like tempeh, natto and tamari.

Myth: Asians consume large amounts of soy foods.

Truth: Average consumption of soy foods in Japan and China is 10 grams (about 2 teaspoons) per day. Asians consume soy foods in small amounts as a condiment, and not as a replacement for animal foods.

Myth: Modern soy foods confer the same health benefits as traditionally fermented soy foods.

Truth: Most modern soy foods are not fermented to neutralize toxins in soybeans, and are processed in a way that denatures proteins and increases levels of carcinogens.

Myth: Soy foods provide complete protein.

Truth: Like all legumes, soy beans are deficient in sulfur-containing amino acids methionine and cystine. In addition, modern processing denatures fragile lysine.

Myth: Fermented soy foods can provide vitamin B12 in vegetarian diets.

Truth: The compound that resembles vitamin B12 in soy cannot be used by the human body; in fact, soy foods cause the body to require more B12.

***
The bottom line is this: f you want to eat soy make sure it's fermented and non-GMO, obviously. Modern soy creations are completely unhealthy and not real food: they are edible food-like substances.
12:50 PM on 02/28/2010
So your saying for about the last 3000 years Asia has consumed an average of "10 grams (about 2 teaspoons) per day."? And it's has not been used instead of different forms of meat?

Mind if I ask where you gets this info, it seem very highly unlikely this is accurate. Especially if you just look at the population numbers, not sure it's possible to feed that many people 10s of centuries without the consumption of more soy products.

Afaik soy products are much more popular or at least were before the terrible diets of the west started becoming available to Asia in the last 50 years of so.
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MrWampler
01:11 PM on 03/01/2010
10 grams is ridiculously low. That's 2 teaspoons of soy sauce. Any cup of miso soup has more than 10 grams of soy. The inarizushi pocket is tofu. A serving of edamame... I wonder what this "average" is averaging.
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12:18 PM on 02/27/2010
One billion Chinese can't be wrong.
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mssreader
eat, read, sleep, read and be happy
01:49 PM on 02/27/2010
And let us not leave out the Japanese either who have enviable longevity.
02:36 AM on 02/28/2010
Average consumption of soy foods in Japan and China is 10 grams (about 2 teaspoons) per day. Asians consume soy foods in small amounts as a condiment, and not as a replacement for animal foods.
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mssreader
eat, read, sleep, read and be happy
10:21 PM on 02/28/2010
opera, where did you get that info? It's not true though what the percentage is I don't know but can easily find out. Tofu is a staple next to rice in Japan. Don't know about China.
12:01 PM on 02/27/2010
This article leaves out so much that I'm not sure one can draw any conclusions from it. In these studies are we replacing cow milk with soy milk? If so, is it commercial pasteurized/homogenized cow milk or raw organic milk? Is the soy organic? Non-organic soy milk is a highly processed, sugary, GMO product that should not be recommended to anyone! Isn't it processed food and sugar that contribute to cancer and a host of other contemporary illnesses? Isn't high estrogen bad for males? Compared to the horror that is commercial cow milk, I would agree that soy is better for you. Why consume either? I don't know who the author is, but I'm very skeptical and personally won't consume any soy products. Also, FYI soy is found in thousands of products as fillers such as supplements.
11:55 AM on 02/27/2010
I'm skeptical that any of those sources come from tightly-controlled clinical trials. Case-Control studies cannot be safely used to tease out any kind of "causation"; they're just a good starting point for more rigorous research.
10:50 AM on 02/27/2010
Wow. I'm glad this ONE doctor on this ONE blog finally settled the ENTIRE soy controversy for us. And in so few words! Thanks, Huffpost!
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Torcho
Artist, Activist, Small Business Owner.
09:53 AM on 02/27/2010
I agree with many of these comments; this is a slanted one-sided article. SOY is a problem, not a solution, especially GMO - ADM/Monsanto related modified soya. The allergy rate to SOY has increased dramatically in the last 20 years. There is soy by-product laced in most commercial foods! READ the ingredients and start to cut SOY out of your diet...
11:02 AM on 02/27/2010
There are two kinds of soy: field/oil soy and garden/vegetable soy.

Field soy makes up over 97% of the domestic soy crop and is mostly GMO. This kind of soy is processed into soybean oil and a defatted soy meal used as animal feed.

Garden soy is small minority of the domestic crop and has no GMO versions as far as I know. This is the kind of soy used to make tofu, soy milk, and protein products.