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 (particularly Asian populations) suggest that soy may help reduce menopausal symptoms, as well as 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 endometrial cancer).

Clinical studies of soy have focused on the protein and isoflavone content of soy foods. Isoflavones are phytoestrogens -- plant compounds are similar to estrogen (a reproductive hormone). Soy phytoestrogens are very complex -- they bind to estrogen receptors and 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.

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 recommendation have found:

Asian populations who routinely 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

The evidence suggesting that soy may be helpful in preventing hormone-related cancers, such as breast, prostate, and endometrial cancer, comes from population studies. These kind of studies examine 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 decreased risk of breast cancer, although a meta-analysis in 2006 of 18 previously published clinical studies found that in healthy women, soy was associated with a small but statistically significant (14%) reduction in breast cancer risk. Some studies seem to suggest that it the best protection may come if a woman eats a diet high in soy when she is young, rather than when she goes through menopause.

The findings are also hard to interpret 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 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 due to their diet. Other researchers have noted that prostate size in Japanese men does not increase as much with age as it does in Western men, and speculate that a high soy diet may be the reason why.

Osteoporosis

Researchers have begun to investigate whether soy foods can help prevent osteoporosis by increasing bone mineral density (BMD). Most of the research has focused on the isoflavone content of soy protein. Although studies are limited, 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, had the most effect.

However, other clinical studies have not found a significant beneficial effect of soy isoflavones on bone mineral density in early postmenopausal women.

Menopause

Soy isoflavones may help reduce hot flashes and night sweats that many women experience 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 with low intakes of soy. Results of studies looking at whether soy supplements can reduce menopausal symptoms have been mixed. Several studies have had a high placebo response. Some researchers also theorize that using soy extracts with different isoflavones in different studies can account for the mixed results. It appears that the studies with the most positive results have used soy products with at least 15 mg of genistein per day.

There are a wide variety of soy foods. The whole soybean (called edamame) and tofu can be found in many Japanese and Chinese dishes and is increasingly 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. One supplement, ipriflavone, is being investigated to see if it may help strengthen bones. So far, there is only limited information.

Pediatric

Soy foods and soy-based infant formula are widely available. But isolated soy products are not recommended for children because there are no clinical studies that show whether isolated soy protein or isoflavone supplements are safe in children.

Adult

Heart Disease: Most clinical 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 details about dosage, frequency of use, or safety are not known. Studies have examined soy foods, not soy supplements. For this reason, some researchers suggest that soy foods should be part of a healthy diet for cancer prevention rather than isoflavone supplements.

If you are undergoing cancer treatment, talk to your doctor about the possible risks and benefits of eating soy foods. Do not use isolated soy products unless under the direct supervision of a knowledgeable health care provider.

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. Specific information about the proper dose, how long to take it, and what the long-term effects of phytoestrogens may be are lacking.

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 soy is believed to reduce 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. Phytoestrogens may reduce the effectiveness of the breast cancer medication tamoxifen (Nolvadex) and should not be used by women with breast cancer who are also taking this drug.

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 or renal dietitian before including soy foods in their diet.

Hypothyroidism

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

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 Breast-feeding

Eating soy foods during pregnancy and while breast-feeding is considered safe.

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.

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 possibly lower soy levels in the body. Further research is needed.

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