To Soy, or Not to Soy?

Making sense of the confusion on soy and breast cancer

By: Karen Brenes

Soy: Friend or foe?
In 2005, I was diagnosed with
fibrocystic breast disease and told that
this condition could moderately increase
my risk for breast cancer. Shocked by
this news, I decided to do everything I
could to help reduce this risk, including
making sweeping changes in my diet. At
the time, the prevailing belief about soy
was that it had a protective effect against
breast cancer, so my doctor
recommended that including soy in my
diet could be helpful.
Embracing this advice with gusto, I
become a vegetarian and tofu, soymilk
and soy energy shakes became my main
sources of protein. When I returned to
my doctor the following year, I was
shocked to find that she had completely
changed her mind about soy. She told
me that new studies were now showing
that soy might actually cause breast
cancer instead of preventing it and that I
should now try to limit my intake of soy.
For the second time in a year, I left her
office reeling. How could doctors and
scientists change their minds so quickly
about soy and offer such contradictory
advice? When it comes to breast cancer,
is soy safe or dangerous?
The latest research has shown that my
doctor was partially right on both visits.
Ultimately, it all comes down to the type
of soy you are consuming. Certain soy
foods have safely been a part of the
human diet for centuries and have
consistently been shown in studies to be
safe for everyone, even women with
breast cancer. These types of soy may
even reduce the risk for certain groups of

women (He & Chen, 2013). Other types

of soy are more questionable and need to
be approached with caution
(McCullough, 2012).
Understanding what is known and not
known about the different types of soy
can help you to make sense of the
confusion and to choose your soy wisely.

Soy isoflavones: Do they cause

or prevent breast cancer?
At the heart of the soy controversy is a
group of chemical compounds naturally
found in soy that resemble human
estrogen and can sometimes mimic its
behavior. Uncertainty over how exactly
soy isoflavones work in the human body
is what has caused most of the confusion
over whether or not soy promotes or
prevents breast cancer.
Thats because many breast cancer
tumors have estrogen receptors (ER+)
that can cause them to grow when
exposed to estrogen. Because of their
similarities to estrogen, researchers
feared that soy isoflavones could also
fuel tumor growth (McCullough, 2012).
These fears were elevated when a small
number of lab studies involving rats
seemed to show that soy isoflavones did
show increase tumor growth (Setchell et
al., 2011).
Human observational studies had very
different results. These large-scale
studies followed populations of healthy
women for many years detailing their
dietary habits and their health. Many of
these studies were done in Asia, where
soy has been a dietary staple for
centuries and they consistently showed

either no association between soy and

breast cancer risk or that higher soy
intake led to lower rates of breast cancer
(Guha et al., 2009).
So what exactly are these soy
isoflavones up to? How can they
promote tumor growth in one set of
studies and prevent it in another?
Its important to understand that even
though isoflavones are similar, they are
still not human estrogen. The effect they
have in the body is extremely weak
compared to real estrogen (Guha et al.,
2009).
Its also important to remember that
results from animal studies will not
necessarily apply to humans. In fact,
more recent studies have shown that rats
metabolize soy very differently than
humans do (Setchell et al., 2011).
Finally, its vital to look at the types of
soy that were used in the different
studies. The animal studies used soy
protein isolates a highly purified and
processed form of soy that is used in
commercial soy supplements and
contained drastically higher amounts of
isoflavones than are naturally found in
the soy foods that were consumed in the
human studies (Guha et al., 2009).
The ways in which soy isoflavones act
to prevent breast cancer are even less
understood, though more studies are
beginning to show that not only can they
act like estrogen, they may also have
anti-estrogenic effects too, which may
even include blocking human estrogen
from ER+ tumors (He & Chen, 2013). A
recent study found that breast cancer
survivors who regularly consumed
moderate amounts of soy foods had
lower rates of reoccurrence then those
who did not.
Another recent study found that soy
isoflavones actually enhanced the effects
of the anti-estrogenic drug tamoxifen

(Gonzales et al., 2014). While more

research needs to be done to confirm
their findings, these studies offer
exciting glimpses into the many different
ways that soy might work to protect
against breast cancer.

What do cancer and nutritional

experts recommend?
Both the American Cancer Society
(AMC) and the Academy of Nutrition
and Dietetics (ADA) feel confident
enough about the safety of dietary soy to
officially recommend that moderate
consumption of traditional, whole soy
foods are safe for all members of the
general population, including women
with breast cancer and breast cancer
survivors.
However, both organizations also
recommend avoiding soy protein
supplements and powders (Dyer &
Dixon, 2013; McCullough, 2012). Marji
McCullough, the strategic director of
nutritional epidemiology for the AMC
explains that this is because they
contain much higher isoflavone
concentrations than you would normally
find in the foods you eat, havent been as
rigorously tested and may have other
potent effects on body tissues
(McCullough, 2012).

What are traditional, whole soy

foods, and how much is a
moderate amount?
Not surprisingly, these are the
minimally processed foods that have
been a part of traditional Asian diets for
centuries. The table on the next page
lists several examples of some of that are
now common and easy to find here in
the United States.
Traditional,

Description

healthy soy
foods
Edamame

Immature soybeans sold

in fresh or frozen form,
are excellent sources of
fiber.
Soymilk
Said to be invented in
China 2,000 years ago,
soymilk is extracted from
soy protein and is similar
in protein and fat content
to cows milk, but free of
lactose and cholesterol.
Tofu
Made by adding salts or
acid to soymilk to form
its characteristic Jell-Olike curd.
Tempeh
Originated in Indonesia
and is made by
fermenting partially
cooked soybeans to form
its characteristic loaf
shape.
Note. Descriptions in the second column
of the table adapted from (He & Chen,
2013,p. 148-149).
Not only have these soy foods been
proven to be safe in human studies, they
are also a heart healthy protein that is
low in saturated fats, rich in omega-3
fatty acids and cholesterol free (He &
Chen, 2013). Some of them are also rich
in fiber, antioxidants and other essential
nutrients that also contribute to lowering
your risk for other forms of cancer and
improve your overall health and
wellbeing (Presley, 2013).
A moderate amount of soy foods is
considered to be up to three servings of
soy per day, with a single serving being
approximately 11g of whole soy protein
or 1 cup of soy milk, cup cooked soy
beans, cup edamame or 1/3 cup tofu
(Presley, 2013).

Avoid or limit highly processed

soy foods
These are products that have been
stripped of most of their nutrients and
are really just the isolated soy protein
and isoflavones. The amounts of
isoflavones in these products havent
been shown to be dangerous to humans,
but they are still just processed junk
foods that dont contribute to good
health.
They include textured vegetable
proteins, soy meat and cheese
products and are also found in many
energy and sports bars (Dyer & Dixon,
2013; McCullough, 2012).

At the end of the day, theres no

real reason to fear soy if youre
soy savvy
Human studies have shown that
moderate consumption of traditional,
whole soy foods are absolutely safe for
everyone, including breast cancer
patients and survivors and may even
have some protective benefits. Not only
are they safe, they can also provide you
with many other nutritional benefits that
can improve your health in general.
Until more research has been done to
firmly establish their safety, its best to
avoid soy supplements altogether and try
to limit highly processed soy foods.
Soy foods are not for everyone, but if
you do enjoy them, theres no reason to
fear or avoid them if you know how to
be smart about your soy.

References

Dyer, D., Dixon, S. (2013, April). Soy

and breast cancer. Retrieved July
2, 2014 from
https://www.oncologynutrition.or
g/erfc/hot-topics/soy-and-breastcancer/

Presley, A. (2013, May). Do soy foods

increase cancer risk? Retrieved
July 2, 2014 from
http://www.mdanderson.org/publ
ications/focusedonhealth/issues/2
013-may/soyandcancer.html

Gonzales, J. F., Barnard, N. D., Jenkins,

D. J., Lanou, A. J., Davis, B.,
Saxe, G., & Levin, S. (2014).
Applying the precautionary
principle to nutrition and cancer.
Journal of the American College
of Nutrition, 33(3), 239-246.

Setchell, K. D., Brown, N. M., Zhao, X.,

Lindley, S. L., Heubi, J. E., King,
E. C., & Messina, M. J. (2011).
Soy isoflavone phase II
metabolism differs between
rodents and humans:
Implications for the effect on
breast cancer risk. The American
Journal of Clinical Nutrition,
94(5), 1284-1294.

Guha, N., Kwan, M. L., Quesenberry Jr,

C. P., Weltzien, E. K., Castillo, A.
L., & Caan, B. J. (2009). Soy
isoflavones and risk of cancer
recurrence in a cohort of breast
cancer survivors: The life after
cancer epidemiology study.
Breast Cancer Research and
Treatment, 118(2), 395-405.
He, F., & Chen, J. (2013). Consumption
of soybean, soy foods, soy
isoflavones and breast cancer
incidence: Differences between
Chinese women and women in
western countries and possible
mechanisms. Food Science and
Human Wellness, 2(34), 146161.
doi:http://dx.doi.org/10.1016/j.fs
hw.2013.08.002
McCullough, M. (2012, August 2). The
bottom line on soy and breast
cancer. Retrieved July 1, 2014
from
http://www.cancer.org/cancer/ne
ws/expertvoices/page/frequentlyasked-questions.aspx