Interview: The Place of Soy in the Health Food Arena
Posted by Joshua Day on Sep 19, 2013 
Healthy Eating Resources 
Health & Beyond editor Josh Day recently sat down with Dr. Kim to ask him a few questions on a topic that's always hot in the health food world. We're talking about soy... what it is, what it does in your body, and why you see soy this and soy that on almost every aisle of your local health food store.
Let's jump straight into the interview, shall we?
Josh: What exactly is soy?
Dr. Kim: Soybeans are legumes - they look like peas in a pod, but they're larger. Soybeans are rich in protein, omega-3 fatty acids, tryptophan, fiber, iron, and a bunch of other minerals.
All of the soy products on the market today - soy milk, tofu, soy sauce, miso, tempeh - they're made using soybeans, and in most cases, additional ingredients are added.
Josh: What’s up with everything we hear about fermented and unfermented soy?
Dr. Kim: Foods made with fermented soy are thought to be healthier than those made with unfermented soy. Examples of foods made with fermented soy are miso, tempeh, and naturally brewed soy sauce. 
Tofu and soy milk are examples of foods made with unfermented soy, although sometimes, tofu, once it’s made, is fermented to produce fermented tofu dishes in East Asian cooking – mostly Chinese.
Josh: Is soy as good for you as many in the health food movement would have us believe?
Dr. Kim: To me, soy is just another food. I think that you can eat soy and be healthy, but you don’t need to eat it to be healthy.
Josh: In health food stores you see "soy" everything -- soy milk, soy dairy, etc. Many people, especially vegans, consume soy as if it were oxygen. They think they're doing their body good but perhaps they're not?
Dr. Kim: Right, I think the most important point here is that it’s best to eat a variety of foods. Anytime you eat too much of one specific food, especially if that food is rich in protein, you may increase your risk of eventually becoming intolerant to that food. I’ve seen this happen to people with soy milk, tahini, almonds, and a number of other protein-dense foods.
Lots of processed foods made with soy – like meat-substitutes – they’re made with soy protein isolate, which is a highly processed food that can’t be as good for us as soybeans that are minimally or naturally processed.
Fermentation is a “natural” type of processing that doesn’t have the potential to hurt the nutrient value of soybeans the way that high temperature processing techniques do.
I think I know what you’re getting at with this question. Some people become vegan and turn to soy cheese, soy burgers, soy hot dogs, soy nuggets, soy ice cream, soy yogurt, soy everything to feel like they aren’t depriving themselves of foods that they enjoyed in the past. The vast majority of these highly processed foods are made with soy protein isolate and preservatives, and in my opinion, they’re no better than French fries, donuts, and regular fast food fare.
Josh: Is "soy" milk or "soy" cheese any better than, say, the bottled parmesan "cheese" that comes in a cardboard can?
Dr. Kim: Soy milk - if it’s made with whole, organic soy beans and it’s not sweetened - I think can be a healthy food choice. But again, the key is to drink it in moderation. A cup or two of good soy milk a few times a week in your smoothies or on your cereal is fine, in my opinion. Soy milk that is made with soy protein isolate and/or has added sugar, even if the sugar is from a “natural” source, like evaporated cane juice, is probably no better for us than Tang. In fact, if it’s made with soy protein isolate, it‘s probably worse than Tang, because with Tang, you aren’t getting highly processed protein into your system.
Soy cheese – my understanding is that some brands of soy cheese contain casein, the protein found in animal milk. And casein is problematic for a lot of people. If you’re going to eat soy cheese, I would say to pick a brand that is casein-free and made with soy milk that is made with whole, organic soy beans. And again, I would recommend eating it in moderation, say a couple of times a week at most.
Parmesan cheese – I don’t know much about how the parmesan cheese that comes in a cardboard can is made, so I can’t say how healthy a food choice it is. What I can say is that any food that is made with pasteurized milk isn’t a great choice because it contains casein that’s been heated at a high temperature. I think that Dr. T. Colin Campbell of The China Study believes that there’s a strong association between casein intake and risk of different types of cancer and other degenerative diseases. I tend to agree with this, but I can’t say the same thing about raw dairy products. Casein that is unheated and found in milk that comes from a healthy animal that is allowed to live in a natural setting may be just fine – just look at groups of people out there – mostly Caucasians – who live long and healthy lives with raw dairy as staples – this includes different types of cheese made with raw dairy.
If you’re asking me to compare soy cheese that is casein-free and made with soy milk that is made with whole, organic soy beans vs. Parmesan cheese that’s grated fresh from one of those big cylindrical blocks made with raw milk, the kind that you see on one of those Food Network travel shows (I think Malto Mario did one of those – is he really Italian? Because he looks Irish to me – Margaret and I have a running bet on this), then I think the answer just depends on each person’s physiology.
For me, being of Asian descent, soy cheese is probably a healthier choice than Parmesan cheese. And for you, being Caucasian, assuming that you aren’t lactose-intolerant, fresh Parmesan cheese is probably the better choice. Just so you know, I don’t eat soy or dairy cheese. Well, sometimes, I get a bit in some food at a restaurant, but this probably happens about once a year at most.
Josh: Do you use soy products in your home? If so, what kinds, and do you believe there is any health benefit?
Dr. Kim: Sure, we use den jang, which is the Korean version of miso – it’s a paste that’s made with fermented soy beans. We get it from a Korean market in Toronto in a big tub. It’s made in Korea with organic soybeans. Mostly, we use it to make den jang soup, which is made by boiling onions, zucchini, spinach, and sometimes some mushrooms in vegetable broth, and adding some of the paste after the vegetables are ready and the heat is turned off. You have to smear the soybean paste along the sides of the pot to get it to blend in with the rest of the soap. Or what Margaret does is she holds a medium size strainer in the soup and uses a spoon to push the den jang through the strainer as it dissolves into the broth.
We also use soy sauce – we usually use Kikkoman – it’s naturally fermented for several months.
When we use soy sauce, we use just a bit, just to add a little flavour. You know you’ve used too much if you wake up the next morning with a swollen face. I did this once when I lived in Korea.
Naturally fermented soy sauce and den jang are rich in friendly bacteria, and den jang is rich in protein, iron, tryptophan – all of the nutrients that I mentioned before are in soybeans – I guess those are the health benefits. Oh, and soy sauce, if it’s made properly, is extremely rich in naturally occurring antioxidants – it’s a much richer source of antioxidants than most types of red wine.
Josh: I love fried rice. A lot of people don't know fried rice is simply cooked rice, white or brown, stir fried in a wok or hibachi grill with soy sauce. Now, I've heard soy sauce is not good for you. Is this true?
Dr. Kim: I think that it mostly depends on the brand that you use. Some companies make soy sauce by boiling soybeans for a day before adding color and artificial flavors – some of these brands contain MSG or compounds that very closely resemble MSG.
Most brands of soy sauce are pretty high in salt, so it’s best to use small bits at a time. People who have health issues that are exacerbated by significant salt intake should probably avoid soy sauce.
Also, a few years ago, a government agency in the U.K. found that some brands of soy sauce contained dangerous amounts of a couple of different chemicals. The thing is, these chemicals were found in brands that were made with the short-cut method. Bottom line: if you use small amounts of a high quality soy sauce that’s been fermented over several months, I think this is fine for most people.
Josh: How prevalent is soy in Korean cooking? I see soy sauce in Japanese and Chinese food all the time.
Dr. Kim: I think that it’s used about as often as we use it. Den Jang (miso) is used to make soup, which is probably eaten a few times a week in most Korean homes. Soy sauce is used to add flavour to some dishes, almost always in small amounts. Soy sauce is also used as a part of marinades for various meat dishes. Ah, and tofu – we sometimes add little cubes of tofu to our soups, and sometimes, Koreans will make a separate side dish with tofu – sometimes cooked, sometimes raw with a sauce that’s made with soy sauce, sesame seeds, and green onions.
Josh: What's the relationship between soy and MSG?
Dr. Kim: My understanding is that quality brands of naturally fermented soy sauce don’t have added MSG or MSG-like compounds. Cheaper brands use hydrolyzed vegetable protein, which behaves like MSG in the body.
Unless you’ve been eating foods with MSG for a long time, it’s likely that your body will let you know whenever you eat something that has added MSG or an MSG-like substance. Some of the more common symptoms that people experience after eating MSG are pounding headaches, heart palpitations, sweating, a flushed feeling, nausea, weakness, and shortness of breath.
Several people have told me that they tend to have really crazy dreams whenever they eat MSG – this makes sense, as MSG is considered an excitotoxin that can rapidly stimulate brain tissue. Bottom line: if you use a high quality, naturally fermented soy sauce, and you use it sparingly, you probably don’t have to worry about getting MSG from soy sauce.
---
Note from Ben Kim: Eating large amounts of unfermented soy products on a regular basis is likely harmful to human health for a variety of reasons, including high phytate content and possible contamination with Aluminum. 
Some in the anti-soy camp point to the potential that soy has to be an "endocrine disruptor," while others in this camp believe that the phytoestrogen content of soy can increase one's risk of developing breast cancer. 
To the best of my knowledge, there are no definitive studies in the peer-reviewed, indexed body of literature that offer conclusive proof to back up these anti-soy claims. I find some of these claims to be in the alarmism zone - for example, to say that any food is an "endocrine disruptor" is a generalization that doesn't mean anything to me, as every food that we eat and every thought that we think technically disrupts our endocrine systems. 
As I mentioned in this interview with Josh Day, I feel that it is prudent to eat foods - including soy - in moderation. And I do feel that it's better for human health to eat fermented forms of soy over unfermented varieties. 
The bottom line for me is that I know enough healthy Korean and Chinese folks in their 80's and even their 90's who have long enjoyed den jang (miso) and tofu to believe that including some soy in one's diet is fine for most people. If you enjoy soy, my advice is to eat the best varieties available to you in moderation, and to be filled with peace and compassion as you eat it.
Fermented vs unfermented soy: friend vs foe
http://essentialstuff.org/wp-content/uploads/2014/09/Silk-vanilla-soy-milk.jpghttp://essentialstuff.org/wp-content/uploads/2014/09/Silk-vanilla-soy-milk.jpgBy Catherine Haug, Sept 9, 2014 (photo, right, from silk.com (3))
The vegetarian, vegan and veggie-juicing communities all promote the consumption of soy and soy products as good for you. Many site that Asians consider soy to be a sacred crop as proof of its goodness. But is this really true? What are the facts and history of soy consumption?
It is true that many Asians consider soy to be a sacred crop, but this is primarily because of the nitrogen-fixing benefit it provides, as a legume, to the soil for growing other crops, not because of any dietary healthfulness. It is also true that many Asians include soy products in their daily diet, but not the same soy products sold in Western countries.
May people site the isoflavones present in soy as being beneficial for health, especially women’s health because of their estrogen-like (phytoestrogen) activity. However, one of soy’s isoflavones – genistein – is believed to have toxicity issues, though more research is needed as various studies report conflicting results (see Fact Sheet: Phytoestrogen Genistein, from Breast Cancer and Environment Research Centers, or BCERC (1). Genistein is present in other foods, including mothers’ milk, but in much lesser quantities than in soy.
What is one to believe? The answer lies in the differences between fermented and non-fermented soy.
Fermented vs unfermented soy products
The following is based on my own research of the literature, and on an article by Nancy T Angelini in Developing Healthy Habits September 2014 newsletter (2).
Ms. Angelini asserts that when it comes to soy, “the devil or the divine is in the details,” and in this case, the details are in the chemistry of how the food is consumed. Specifically, the differences between “fermented soy, sprouted soy and unfermented soy,” and in whether or not the consumer has a food allergy to soy or its constituents.
Soy’s isoflavones can have an inhibiting effect on reproduction in humans; different results are obtained when fermented soy, such as miso or natto are used, vs unfermented soy, such as soy milk are consumed. (See below for more examples of each type)
•	In unfermented soy products including the whole bean, the isoflavones are in their inactive glycosidic form which is the most problematic; 
•	In sprouted and fermented soy products, the isoflavones are in the active aglycone form which provide healthful benefits.
In other words, if a researcher is feeding his subjects with unfermented soy products, the results are likely to indicate toxicity and/or allergenicity; if a researcher is feeding his subjects with fermented or sprouted soy products, the results are likely to indicate a health benefit.
A cross-sectional study published in the International Journal of Women’s Health in April 2014 found soy may have a significant impact on a woman’s ability to become pregnant with a diet containing more than 40 g of isoflavones from dietary soy IF the soy is not fermented. In other words, Asian women consume 25 – 50 g of fermented soy in their daily diet, and they have high birth rates. In US and other Western countries, where the impact on pregnancy rates is noted, most of the soy that is consumed is not fermented.
Allergenicity of unfermented soy vs fermented soy
A study published in the Journal of Nutrition and Science of Vitaminology in 2013 demonstrates that the longer the fermentation time, the lower the levels of allergens in various miso pastes. A second study in 2014 found that 24 hours of fermentation drastically reduced the inactive (allergenic) form by conversion to the active (beneficial) form.
However, inactive isoflavones are not the only potentially allergenic constituent in unfermented soy products. I have a significant allergy to monosodium glutamate (MSG) which is produced when soy’s proteins are hydrolyzed, such as the production of soy protein powder or TVP. My personal reaction to such products is fairly severe intestinal distress and pain, similar to that caused by gluten for those with gluten allergy.
Other benefits of fermented soy
Soy has been promoted as preventing bone loss, such as a 2006 study published in the Journal of Nutrition on osteoporosis. This study demonstrated that natto (a fermented soy product) may help prevent bone loss through the effects of an activated isoflavone called MK7. The study did not use unfermented soy, so no comparison can yet be made.
Fermented and unfermented soy products
Fermented soy product, which are common in Asian countries and provide health benefits include:
•	natto, 
•	miso, 
•	tamari (fermented soy sauce), 
•	tempeh 
•	fermented or ‘stinky’ tofu. 
•	Sprouted soy can be included in this group, so if you wish to cook soy beans, sprout them first to minimize toxicity. If you make your own soy milk, sprout the beans first.
Unfermented soy products, which are the most common in the US and should be avoided, include:
•	soy flour, 
•	soya sauce, 
•	soy milk (also soy margarine, soy yogurt, soy ice cream and soy cheese), 
•	infant formula, 
•	soy protein powders, 
•	veggie burgers containing soy, 
•	textured vegetable protein (TVP), 
•	tofurkey, 
•	soybean oil, 
•	soy in pet foods, 
•	soy products/additives are also found in many supplements and ‘health foods,’ and most likely come from unfermented soy.
Note that most soy in the US is also a GMO product, unless it is 100% Organic.
Differences Between Soybeans and Edamame Last Updated: Jun 24, 2015 | By Natalie Stein 

A bowl of edamame on a table. Photo Credit Juanmonino/iStock/Getty Images 
Soy is a natural source of many essential nutrients, and it can usually be a healthy addition to a balanced overall meal plan. Examples of soy-based products include tofu, miso, soymilk, soy burgers, soybeans and edamame. The difference between soybeans and edamame is in the level of maturity when the beans are harvested. Soybeans are mature, while edamame is harvested while the beans are still young and soft. Soybeans and edamame have many similarities, but it is worth investigating their differences to help you decide which to use.
Background and Uses
You can make soybeans into products such as miso, soybean paste, tofu, soybean curd, tempeh or fermented soybeans; however, you can also eat soybeans on their own. Roasted soybeans are also called soy nuts, according to the University of Michigan. Edamame beans are less mature, sweeter soybeans that you eat when they are still green. Eat them for snacks, in stir-fry, salads or add them to chili as per the National Garden Bureau.
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Calories and Protein
Each cup of raw edamame, or green soybeans, provides 376 calories, while a cup of mature raw soybeans has 830 calories. Each cup of edamame has 33 grams of protein, and soybeans have 68 grams of protein, or 136 percent of the daily value. The protein from soybeans and edamame beans is high-quality, or complete, which means that it provides each of the essential amino acids which you need to get from the diet, according to the University of Michigan.
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Fat and Carbohydrates
Edamame has 17 grams total fat, and raw, mature soybeans have 37 grams fat per cup. Saturated fat raises levels of LDL cholesterol in your blood, and edamame has 2 grams, compared to 5 grams saturated fat in soybeans. Each cup of raw edamame provides 28 grams total carbohydrates, including 11 grams dietary fiber. Raw soybeans provide 56 grams carbohydrate and 17 grams fiber. Dietary fiber is an essential nutrient, which lowers your cholesterol levels and may help stabilize your blood sugar.
Vitamins and Minerals
Soybeans have 679 micrograms folic acid per cup, and edamame beans have 35 micrograms folic acid, which is essential for preventing neural tube birth defects. Raw soybeans have more than 500 milligrams calcium, or more than one-half of the daily value for calcium, which you need for strong bones. Edamame has 71 milligrams of calcium per cup. The daily value for iron is 18 milligrams, and edamame beans have 2 milligrams, while soybeans have 29. Both kinds of beans are low in sodium
Soyfoods in Asia: How Much Do People Really Eat?
By Ginny Messina on March 1, 2011 in Uncategorized 
Way back in the fall, when I reviewed The Vegetarian Myth, I promised to follow-up with some perspective on the controversies surrounding soyfoods. I know that Jack Norris is working on a fairly comprehensive overview of this topic which will hopefully be available soon. I’ll be adding some information to my website as well. For now, I wanted to look at the important issue of soy consumption in Asia. It’s an area of some confusion since a common belief is that Asians consume only small amounts of soy—sort of condiment-style—and that they consume mostly fermented soy products like miso and tempeh. Based on the research, though, neither of these assumptions is true. 
The confusion about how much soy Asians consume is based partly on a simple mathematical misunderstanding. In studies of intake, findings are sometimes expressed as the amount of soy protein that people consume—which is different from the total amount of soy food in their diets. For example, according to surveys in Japan, older adults consume around 10 grams of soy protein per day, which is the amount of protein in about 1 to 1 ½ servings of traditional soyfoods. Because a number of authors have misunderstood the relationship between soy protein and soyfood, they’ve greatly underestimated the amount of soy in Japanese diets. 
Information about soy intake in Asia comes from a number of different resources including studies designed to examine the effects of diet on health, Japan’s National Nutrition Survey, and the Food and Agriculture Organization (FAO) of the United Nations. The most important of these are the studies designed to look at diet and disease relationships because many of them evaluated soy intake comprehensively. That is, they recorded frequency, and amounts of all types of soy products consumed using validated dietary intake instruments. 
The results show a fairly wide range of intake among different countries and even within populations. While average Japanese intake is 1 to 1 ½ servings, the surveys reveal that the upper range among older Japanese—who would be expected to eat a more traditional diet—is about 3 servings of soyfoods per day. 
It’s much harder to determine soy intake in China because diets vary greatly across regions. The most extensive data are available for Shanghai where large studies of health habits include dietary data from close to 100,000 adult men and women. Average intake in Shanghai is a little bit higher than in Japan. But the range of intake is extensive and a large number of the adults in these studies—as many as 15 to 20 percent of the men and 10 percent of the women—consumed 2 to 3 servings of soyfoods per day. 
With the exception of Hong Kong, there isn’t quite as much data on soy intake in other countries and regions. But, the available findings suggest that, compared to Japan and Shanghai, soy consumption is much lower in Hong Kong and Thailand, about the same in Indonesia, and a bit higher in North Korea. 
And contrary to popular opinion, the soy products regularly consumed in these countries are not all—or even mostly—fermented. In Japan, about half of soy consumption comes from the fermented food miso and natto and half comes from tofu and dried soybeans. In Shanghai, most of the soyfoods consumed are unfermented, with tofu and soymilk making the biggest contributions. In fact, even in Indonesia, where tempeh is a revered national food, unfermented soy products like tofu account for around half of soy intake. 
Soyfoods have been consumed in China for at least 1,500 years and in Japan for 1,000 years. The evidence shows that soyfoods—both unfermented and fermented—continue to be a significant part of traditional Asian diets. There is no reason why western vegans can’t include these foods in meals as well.
How Soy Can Kill You and Save Your Life
http://drhyman.com/wp-content/uploads/2010/08/soy-for-hyman-blog.jpghttp://drhyman.com/wp-content/uploads/2010/08/soy-for-hyman-blog.jpg
EATING SOY CAN KILL YOU! Scan the media reports and surf the Internet, and you’re bound to come across scary claims that would lead you to believe this is true. You may have heard:
•	Soy will give you breast cancer. 
•	Soy formula is dangerous to babies. 
•	Genetically modified soy foods may modify you. 
•	Soy foods block your thyroid function. 
•	Soy prevents the absorption of minerals and interferes with digestion. 
•	Tofu causes Alzheimer’s disease.
As some of you may be aware, I often recommend soy as part of a whole foods diet. Many people question why I include these foods in light of such startling media coverage on the dangers of soy. The reason is relatively simple.
I have reviewed reams of research and many claims for and against soy foods. From the studies available, I can tell you that soy is neither as good as the proponents say, nor as evil as the critics claim. I wish we had more convincing science to report, but we don’t. The key is to take all the available evidence together and see what shakes out.
In today’s blog I have done that for you. I will review some of the recent data for and against soy, and provide you with a few guidelines and things to remember when choosing soy foods.
What the Data Says about Soy
If you want an excellent, unbiased, scientifically sound review of all the relevant human data on soy, I recommend reading the 100-page report from the Agency for HealthCare Research and Quality entitled, The Effects of Soy on Health Outcomes, which reviewed thousands of studies based on rigorous criteria for scientific validity. Its conclusion was this: There is no evidence of significant benefit or harm based on the quality of evidence that exists today.
The dangers of soy are overstated. The benefits may be too.
So what’s a confused consumer to do? Give up on soy until we know for sure? Or chow down on soy nuts? Don’t panic. There are some things we do know about soy, both good and bad.
First, you should be aware that the amount of soy used in many of these studies was much higher than what we normally consume — the average dose of soy was equivalent to one pound of tofu or three soy protein shakes a day. That’s a lot of soy! Most people just don’t eat like that. So when you read negative things about soy, remember that many of those claims are based on poorly designed studies that don’t apply to real-world consumption.
You could apply that thinking to other studies, too — like those that show that broccoli contains natural pesticides or that celery is high in toxins. Sure, those foods might cause you some problems — but not in the amounts that most of us eat. The same is true for soy.
Second, it’s important to recognize that many of the common claims about soy simply don’t pan out when you look at the evidence carefully. Let’s review four of these claims and the science behind them so you can have a better understanding of the real relationships between soy consumption and potential health threats.
http://www.eatfatgetthin.comhttp://www.eatfatgetthin.com
#1 “Soy Causes Breast Cancer”
Because soy foods contain natural plant compounds (called isoflavones) that appear to work like hormones, some people worry that they could increase hormonally driven conditions like breast cancer. But that doesn’t seem to be the case. In fact, research findings (i) suggest just the opposite:
•	All population studies (studies of groups of people) of soy either show reduced breast cancer risk or no effect. 
•	The only studies to show increased cancer risk are on mice with no ovaries or damaged immune systems who eat high amounts of processed soy. 
•	Studies in mice WITH ovaries and functioning immune systems show inhibition of tumor growth. 
•	Mice studies may not reflect the effect of soy on humans (in case you didn’t notice, mice and humans are not the same species). 
•	High breast tissue density is linked to a higher risk of breast cancer. Breast tissue density increases with estrogen replacement, but decreases with isoflavone consumption in postmenopausal women. That’s a good thing. 
•	Eating soy foods at an early age (childhood and the teen years) appears to have a significant protective effect against breast cancer.
If you really want to reduce your risk of breast cancer, drink less alcohol and eat less trans and saturated fats — all of these compounds may raise risk in high amounts. If it’s a choice between chicken nuggets and tofu, I recommend tofu!
#2 “Soy Formula Could Harm a Baby’s Development”
Some 20 million infants have used soy formula since the 1960s — but some people are concerned that the isoflavones it contains could affect a child’s growth and reproductive development. Yet the only large, long-term study on humans, published in the Journal of the American Medical Association, (ii) found that there were no major health differences in 811 men and women between the ages of 20 and 34 who had been fed either soy or milk formula as infants.
More recently, a report issued by the National Toxicology Program Center for the Evaluation of Risks to Human Reproduction concluded that there just isn’t enough human or animal data to say for sure whether soy formula harms a baby’s developmental or reproductive health.
So what should a mother do? First, breastfeed if at all possible, for as long as possible — ideally until your child is one year old. If that’s not possible and you have to use soy- or dairy-based formula, don’t beat yourself up about it. If there are any risks, they are likely to be very small. Hopefully, continuing research will shed more light on this question.
#3 “Soy is a Thyroid Poison”
I think this claim makes a mountain out of a molehill. Yes, there’s no doubt that soy can affect your thyroid gland — the real question is, how much does it take? If you’ve read that soy is bad for your thyroid, you’re probably reading claims based on a few poorly-designed studies that have been blown out of proportion.
Instead, consider this: A review of the research found no significant effects of soy on the thyroid except in people who are iodine deficient — a condition that is rare in this country.
Another well-designed study in the American Journal of Clinical Nutrition (iii) studied the effect of realistic amounts of soy protein on hormones, including thyroid hormone. It found that soy had no significant effects on these hormones.
Based on my assessment of this and other research, I am convinced that normal amounts of traditional soy foods pose no risk to thyroid function.
#4 “Fermented Soy is Better than Non-fermented Soy”
Now here’s a claim that DOES have some basis in fact. That’s because soybeans — along with other beans, nuts, and seeds — contain compounds called phytates, which bind to minerals inside your body and contain some potentially harmful compounds.
The Asian cultures that have traditionally consumed soy typically ferment it first. This process breaks soy down and makes it easier to digest. Plus, fermentation adds extra nutrients and probiotics (“good” bacteria) to soy. For these reasons, I prefer fermented soy foods, like miso, natto, tempeh, tofu and some brands of soy milk.
So, should you eat soy? My answer is YES — but with two very important guidelines:
1.	Say YES to whole, real soy. The Okinawans are the world’s longest-lived people, probably in part because of their diet. For more than five millennia, they’ve eaten whole, organic and fermented soy foods like miso, tempeh, tofu, soy milk, and edamame (young soybeans in the pod). One to two servings a day of any of these foods are fine.
2.	Say NO to processed soy. That includes soy protein isolate and concentrates, genetically engineered soy foods (typically made from Monsanto’s Roundup soybeans), soy supplements, and soy junk foods like soy cheese, soy ice cream, soy oil, and soy burgers. They don’t have the thousands of years of traditional use that whole soy foods do, are processed, and contain unhealthy fats and other compounds. I have real concerns about these types of soy.
In truth, good human studies on soy are limited, but those we do have suggest that soy may help lower cholesterol, prevent cancer, increase bone density, protect the kidneys of people with diabetes, and relieve menopausal symptoms like hot flashes.
When you are considering the media reports about soy, here are some things to remember:
1.	The dangers of soy are overstated (and the benefits may be, too).
2.	We eat far too much processed soy (and processed foods in general). Stay away from those in your diet including soy protein concentrates or isolates, hydrolyzed or textured vegetable protein, hydrogenated soy bean oil, non-organic sources of soy, and soy junk food like soy cheese and ice cream. Don’t eat them.
3.	Whole soy foods can be a source of good quality protein and plant compounds that help promote health.
4.	Eat only organic soy. Stay away from genetically modified versions.
5.	Replace soy oil with olive oil, fish oil, nuts, and seeds.
6.	Breastfeed your child. I prefer that no one feed dairy or soy formula to their babies, but if you have to, try not to worry about it.
7.	Don’t worry about soy’s effect on breast cancer if you eat it in the forms and amounts I recommend. It has even been shown to protect against breast cancer if you start eating it at a young age.
8.	The effects on the thyroid are not significant or relevant unless you are deficient in iodine (which you can easily get from eating fish, seaweed or sea vegetables, or iodized salt).
I’m eager to see more research on the effects of soy on our health. But as we wait for more studies, there’s no need to pass up this healthful and delicious food. It can be safely included as part of a whole foods diet — which is one of the most important keys to lifelong vibrant health.
Have you experienced any health problem because of eating soy?
Have you experienced any health benefits from consuming soy?
Do you agree or disagree with any of the arguments about this controversial subject that I’ve listed?
Let me know your thoughts by leaving a comment below.
To your good health,
Mark Hyman, MD
References
Soy: What's the Harm?
by Jack Norris, RD
(Last updated March, 2011)
An abridged, less technical version of this article is Response to Not Soy Fast.
Regarding soy and breast cancer, also see The Bottom Line on Soy and Breast Cancer Risk by Marji McCullough, ScD, RD of the American Cancer Society (2012).
Contents
•	Summary 
•	Introduction & Background 
•	The Isoflavones 
•	Soy Servings 
•	Soy Foods 
•	Benefits of Soy 
•	Asian Intakes
•	Breast Cancer 
•	Reviews 
•	Retrospective Studies 
•	Observational Studies of Women Initially without Cancer 
•	Breast Cancer Survival and Recurrence 
•	Breast Tissue and Nipple Aspirate
•	Thyroid 
•	Introduction 
•	Reviews 
•	Primary Studies 
•	Secondary Studies
•	Infant Formula 
•	Reviews 
•	Research
•	Cognition 
•	Long-term Studies 
•	Clinical Trials 
•	Conclusion
•	Hexane 
•	Mineral Absorption 
•	Calcium 
•	Zinc 
•	Iron 
•	Magnesium 
•	Fermentation
•	Feminizing Characteristics 
•	Case Reports 
•	Gynecomastia - Male Breasts 
•	Sperm 
•	Review
•	Endometrium 
•	Ovarian Function 
•	Fertility 
•	Glutamate 
•	Hypospadias 
•	References 
•	Reviewed
Summary
There is a great deal of controversy surrounding soy foods, mostly due to their isoflavones which can bind to estrogen receptors and affect thyroid hormone.
There is significant evidence that eating moderate amounts (one to two servings per day) of traditional soy foods, whether fermented or not, can reduce the risk of prostate cancer and can lower LDL cholesterol.
People have been concerned that moderate amounts of soy could increase the risk of breast cancer or be harmful to women with breast cancer, especially if their cancer is estrogen receptor positive. However, the research to date has been quite reassuring, showing mostly benefits for breast cancer prevention.
Everyone who eats soy should make sure they are getting enough iodine. People with hypothyroidism might need their synthetic thyroid hormone dosage adjusted if they start eating more soy due to the possibility that soy might interfere with it. There is some concern that eating soy could push some people with subclinical hypothyroidism into overt hypothyroidism, so limiting soy for such people might be a good idea.
Soy infant formula has been shown to be safe except possibly for infants with congenital hypothyroidism, whose thyroid function should be monitored. Soy formula is not intended for pre-term infants.
While one observational study found that tempeh was linked to better cognition in older people, tofu has been associated with worse cognition. This is most likely due to confounding variables, including tofu being processed with formaldehyde in Indonesia. Many clinical studies have found that soy increases cognition. Unless you are in Indonesia, you do not need to worry about tofu harming cognition.
Some soy meats or foods containing isolated soy protein are processed with hexane and there may be small amounts of hexane residues in the final product. It is not known if this is harmful, but it might be a good idea to use soy foods from companies who do not use hexane in their processing methods (linked to below).
The phytates in soy can lower the absorption of calcium, zinc, iron, and magnesium. However, you do absorb these minerals from soy foods and eating moderate amounts of soy should not cause deficiencies.
At moderate amounts, soy does not cause feminine characteristics in men. At high amounts, as in twelve servings a day or more, a small percentage of men who are particularly sensitive to soy might develop tender, enlarged breast tissue.

Introduction & Background: Why the Fuss?
By far, soy is the most controversial of plant foods, with gluten taking a distant second place.
Much of the controversy is due to some fairly unique components of soy, isoflavones. Isoflavones are also called phytoestrogens or "plant estrogens", because they can attach to estrogen receptors in cells. The estrogenicity of soy has raised questions of potential benefits, such as for bone health of post-menopausal women, as well as concerns such as for women with estrogen receptor positive breast cancer.
In addition to the isoflavones, soy also contains phytates that can bind minerals and lower their absorption from foods.
Between 1990 and 2010, there were over 10,000 peer-reviewed journal articles on soy (122). A large percentage of these were conducted in animals which can make the results irrelevant to humans because species differ in how they metabolize soy isoflavones and because the amount of isoflavones given to the animals is often much greater than any human would eat. This much research makes soy one of the most researched foods and also increases the chances of finding results that are outliers - studies that by random chance, or the inability to control variables, could show soy to be harmful (or helpful) when it actually is not. The large number of studies allow people who want to make a case against soy to simply highlight a handful when the bulk of research provides a different view. Of course, someone could make a case in favor of soy in the same way. It is, therefore, important is to perform a comprehensive review of the research on any given topic, which I do below for the most important controversies surrounding the potential harm of soy foods.
The Isoflavones
Because some studies look at individual isoflavones, I will give a little background on them. Table 1 shows the breakdown of the typical isoflavone components of soy foods.
Table 1. Typical Isoflavone Content of Soy122				
Isoflavone	If Fermented	% of Total		
genistin	genistein	~40%		
daidzin	daidzein	~40%		
glycitin	glycitein	~5-10%		
In addition to the three main soy isoflavones, there is a fourth isoflavone-related compound, equol, that is produced from daidzin by bacteria that about 25% of Westerners and 50% of Asians and vegetarians have in their digestive tracts (130). Equol has somewhat more estrogenic activity than daidzein and genistein, which has made comparing equol producers the subject of some specific research referenced below.
The isoflavones in soy foods are absorbed almost exactly the same as from supplements (131). After ingesting isoflavones, blood concentrations of genistein and daidzein peak after 5.5 and 7.4 hours respectively; they have a half-life of about 8 hours, meaning 50% will be gone after 8 hours, 75% after 16 hours, and 88% after a day (132). However, if you eat them daily, you will have some in your blood all the time. 
There are other isoflavones, the most studied of which are the isoflavones in red clover. These are not the same isoflavones as found in soy.
Soy Servings
In the research discussed here, soy is typically described in grams of protein or milligrams of isoflavones. Less frequently, soy is described in grams of total soy foods. To make things more complicated, sometimes the participants in research are given only soy protein concentrate (about 65% protein), the isolated soy protein (about 90% protein), and sometimes only isolated isoflavones.
A rough guide is that one serving of soy equals 1 cup of soymilk, or 1/2 cup of tofu, tempeh, soybeans, or soy meats. This is the rough equivalent of about 8 to 10 grams of soy protein and 25 mg of isoflavones. The more processed soy meats tend to have more protein (but fewer isoflavones per gram of protein).
Soy Foods
Some people who write about soy suggest that fermented soy foods are the most healthy, and that isolated soy proteins are the most unhealthy. Fermented soy foods are tempeh, miso, and natto. As will be discussed below, for the most part, the evidence does not suggest that fermented soy foods are healthier than traditional non-fermented soy foods (such as tofu and soymilk). And much of the research on soy showing benefits has been performed on isolated soy protein.
In the United States, whole soybeans are usually eaten in the form of edamame, tempeh, or soy nuts. Many, but not all, soy meats, as well as texturized soy protein, are made from soy protein concentrate or isolated soy protein. Turtle Island, the makers of Tofurky, use pressed tofu to create their soy meats.
Benefits of Soy
I do not attempt to comprehensively review the benefits of soy in this article. Because they should also be considered, I will briefly cover them.
Lowering Cholesterol
A 2006 review of six meta-analyses on soy and cholesterol levels concluded, "In summary, the systematic reviews suggest that the effect of [a diet containing isolated soy protein with] around 90 mg/day of isoflavones is to reduce LDL cholesterol modestly (by around 5%), without clear effects on triglycerides or HDL cholesterol." (125)
Prostate Cancer
A 2009 meta-analysis on soy and prostate cancer found that soy, in the highest versus lowest intake categories, was associated with a statistically significant, 26% reduction in prostate cancer risk (0.74, 0.63-0.89) (1). When separately analyzed, studies on non-fermented soy foods yielded a reduced risk of 30% (0.70, 0.56-0.88), and fermented soy foods were not associated with a decreased (or increased) risk of prostate cancer. It should be noted that the highest intake categories in these studies tended to be low, with most being less than one serving per day.
Menopausal Symptoms
A 2009 paper from the 8th International Symposium on the Role of Soy in Health Promotion and Chronic Disease Prevention and Treatment reported that soy isoflavone supplements containing at least 15 mg of genistein per day have been consistently effective at reducing hot flashes (126). If that much genistein is not provided, then there is little benefit, and is the reason why previous reviews, such as a 2006 meta-analysis (5), provided mixed results.
Asian Intakes
Japan and China have lower rates of heart disease and many cancers than do Westerners. People have suggested this could be due to the soy in their diet. In response, soy opponents have often argued that the traditional Asian intake of soy is much lower than is commonly thought. Typical Asian intakes of soy vary among countries and areas. In Japan and Shanghai, China, average intakes are about 1.5 servings per day, but many people consume an average of two or more servings per day. About half the soy eaten in Asia is not fermented.
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Breast Cancer
Summary: The vast majority of the evidence is that soy is either neutral or protective against breast cancer, including for women previously diagnosed with estrogen receptor positive breast cancer (tumors stimulated by estrogen contact). This evidence is mostly limited to amounts of two servings per day or less.
Reviews
In their 2010 review, Hilakivi-Clarke et al. sum up the evidence on soy and breast cancer (40):
Results reviewed here suggest that women consuming moderate amounts of soy throughout their life have lower breast cancer risk than women who do not consume soy; however, this protective effect may originate from soy intake early in life. We also review the literature regarding potential risks genistein poses for breast cancer survivors. Findings obtained in 2 recent human studies show that a moderate consumption of diet containing this isoflavone does not increase the risk of breast cancer recurrence in Western women, and Asian breast cancer survivors exhibit better prognosis if they continue consuming a soy diet.
Retrospective Studies
In retrospective studies, past diets (provided by memory) of subjects with breast cancer are compared to those without breast cancer. Retrospective studies are less expensive and faster than following people prospectively (forward in time) but are considered less reliable due to inaccuracies in recalling past diet. They generally provide ideas of what connections to investigate prospectively. Nonetheless, the findings from the retrospective studies have shown soy to be either neutral or beneficial in protecting against breast cancer.
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Observational Studies of Women Initially without Cancer
In typical observational studies, you start with people who are apparently healthy and follow them prospectively, without any clinical intervention. The observational studies on soy and breast cancer can be divided into two groups - those done on populations with very low intakes and those done on populations with higher intakes.
The studies done on populations with very low intakes do not provide much evidence. In a couple of cases they actually found an association that reached statistical significance, but if you look enough for associations, you are bound to find some eventually due to random chance.
Observational Studies with Very Low Soy Intakes
As stated above, studies with very low soy intakes do not provide much evidence. But for the record, since 2001 there have been six observational studies on such populations. One of those studies, EPIC-Norfolk (2004), did find an association between soy intake and breast cancer, but the intake of soy was so small as to make the finding likely due to random chance.
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Observational Studies with Higher Soy Intakes
Of the studies done on populations with higher soy intakes (about one to two servings per day as a typical upper intake amount), the Singapore Chinese Health Study (21), the Shanghai Women's Study (22, 23), and the Japan Public Health Center (26) study all found that higher intakes of soy were associated with a reduced risk of cancer. The Japan Collaborative Cohort Study (17) and the Japan Life Span Study (30) found no association. European Prospective Investigation into Cancer-Oxford (24) which contained a large number of vegetarians, also found no association, but this could be because exposure to soy might be more protective when breast tissue is developing during adolescence, while Western vegetarians often come to the diet as adults.
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Breast Cancer Survival and Recurrence
Women’s Healthy Eating and Living Study, USA (2011)
The Women’s Healthy Eating and Living (WHEL) study is a randomized controlled trial of a high fruit-vegetable-fiber and low fat dietary intervention in early stage breast cancer survivors (121). It had a median follow-up of 7.3 years from the time of enrollment. Soy intake was measured post-diagnosis (median 2 years, range: 2 months to 4 years) using a food frequency questionnaire that included specific items for "Meat Substitutes (such as Tofu, Veggie Burgers)," and "Soy Milk", as well as an opportunity to include other soy foods and supplements.
Isoflavone intake (the marker for soy) was unrelated to the risk of recurrence regardless of hormone receptor status or Tamoxifen use. No significant increased or decreased risk was associated with any specific level of intake. Risk of death tended to be lower as isoflavone intake increased (p for trend=0.02). Women at the highest levels of isoflavone intake (>16.3 mg/day isoflavones; equivalent to at least 1⁄2 cup soymilk or 2 oz tofu) had a non-significant 54% reduction in risk of death compared to the lowest one-fifth of soy intake.
The authors state:
Our study is the third epidemiological study to report no adverse effects of soy foods on breast cancer prognosis. These studies, taken together, which vary in ethnic composition (two from the US and one from China) and by level and type of soy consumption, provide the necessary epidemiological evidence that clinicians no longer need to advise against soy consumption for women diagnosed with breast cancer.
Of the other studies, one from the Cancer Hospital of Harbin Medical University, China (2010) (31), the Shanghai Breast Cancer Survival Study (2009) (11), and the Long Island Breast Cancer Study (2007) (32) found soy to be associated with a lower risk of breast cancer or death in some subgroups. Neither those studies nor the Shanghai Breast Cancer Study (2005) (33) or the Life After Cancer Epidemiology Study from Northern California and Utah (2009) (34) found any statistically significant increase in breast cancer, including among women with estrogen positive breast cancer (11, 33, 34).
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Breast Tissue and Nipple Aspirate
Non-lactating nipple aspirate might be a risk for breast cancer, although the data is mixed, and it is likely that what is more important is whether certain types of cells are found in the aspirate (129).
There have been three studies measuring the effects of soy on nipple aspirate. One was conducted in women diagnosed with breast cancer and it found increased aspirate after two weeks in the high soy diet, although there was no increase in breast cell proliferation (35). In two longer term studies of six months on women without a diagnosis of breast cancer, one study found increased nipple aspirate in women while on a higher soy diet of 45 mg of isoflavones per day (there was no placebo group) (37). The other found no increase in nipple aspirate on the high soy diet (2 servings per day) when compared to the low soy diet (< 3 servings per week) (129). At this time, it appears that there is little concern regarding soy and nipple aspirate in amounts up to two servings per day. 
In two other studies of breast tissue, no difference was found between the high and low soy diet groups (38, 39)
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Thyroid
Summary: Almost everyone who has a reliable source of iodine can safely eat soy without it causing thyroid problems. Although most studies that have measured thyroid function and soy intake have found no problems, a 2011 study (78) of people with subclinical hypothyroidism found an increased rate of progression to overt hypothyroidism. For such people, it might be wise to limit soy. People with overt hypothyroidism who substantially change their soy intake might need to talk to their doctor about adjusting their synthetic thyroid medication. 
Introduction
The thyroid gland produces hormones, triiodothyronine (T3) and thyroxine (T4), that regulate metabolism. Thyroid stimulating hormone (TSH), made by the anterior pituitary gland, increases in response to the body's need for more T3 or T4.
Isoflavones in soy can inhibit thyroid peroxidase (TPO) (77), an enzyme involved in the synthesis of the thyroid hormones. This mostly happens when someone is deficient in iodine. If left unchecked, this can lead to hypothyroidism and even an enlarged thyroid gland, known as a goiter. 
Reviews
In their 2006 review article, Messina and Redmond write (77):
The preponderance of evidence from clinical trials involving healthy adult men and women indicates that neither soy protein nor isoflavones adversely affect thyroid function. As noted the adverse effects reported by one Japanese study [Ishizuki Thyroid Clinic, (67)] are biologically implausible and contrast with the results of 13 other trials. Thus, despite their ability to [inhibit thyroid peroxidase] in vitro and in vivo in rodents, isoflavones do not appear to cause thyroid hormone abnormalities in euthyroid individuals [people with genetically normal thyroid function]. Nevertheless, research aimed at determining whether further depression of thyroid function in individuals with pre-existing subclinical hypothyroidism occurs in response to soy intake is warranted.
Messina and Redmond also point out that soy might interfere with the absorption of synthetic thyroid hormone.
In their 2002 review article, Doerge and Sheehan write (76):
Iodine deficiency is an emerging concern in elderly Americans. Consumption of iodized salt, the primary source of dietary iodine, may decrease with the desire or need to reduce the possible hypertensive effects of high salt intake. The data presented here suggest that elderly women need to be aware of, and monitored for, possible thyroid problems resulting from consumption of soy products. Those post-menopausal women who consume large amounts of soy products may be at higher risk.
Primary Studies
Hull Royal Infirmary, United Kingdom (2011)
This study was done on people who were found to have subclinical hypothyroidism (defined as a TSH value between 5 and 15 mU/liter; normal range is 0.5–4.7 mU/liter) (78).
It was a randomized, double-blinded, crossover study of 60 patients (8 men, 52 women), ages 44–70. The two study periods lasted eight weeks each and consisted of 30 g of soy protein that provided either 2 mg of isoflavones or 16 mg of isoflavones with an eight week washout period in between. An isoflavone intake of 2 mg per day is typical of Western populations, while 16 mg is typical of vegetarian intakes. The subjects had normal iodine levels ( >100 µg/liter).
Six patients, all women, developed overt hypothyroidism after the 16 mg isoflavone phase, while none did after the 2 mg phase. The overt hypothyroidism appeared permanent, with no reversal on isoflavone withdrawal, although to determine this fully they should have discontinued thyroid hormone for a period, which they did not do. The underlying cause is unclear, although acceleration of an underlying autoimmune process is a possibility.
The authors state:
In a prospective study looking into the spontaneous course of hypothyroidism in females, the rate of progression of subclinical hypothyroidism to overt hypothyroidism was 5.6%/yr. Extrapolating the data from this 8-wk study to give a rate of progression per year, it was expected that in our study population, 3.36 cases per year would progress to overt hypothyroidism; this translates into a standardized rate ratio of 3.6 (95% confidence interval = 1.9, 6.2), i.e. supplementation with 16 mg phytoestrogen caused a 3-fold increase in progression from subclinical to overt hypothyroidism in this study....There are currently no data to guide what effect longer periods of exposure would have on thyroid function, with the possibilities that more overt hypothyroidism may result, stabilization may occur, or thyroid function could improve with thyroid adaptation to the phytoestrogen load. 
The authors conclude that female vegetarian patients with subclinical hypothyroidism may need careful monitoring.
The good news was that the high isoflavone phase produced a significant reduction of blood pressure, c-reactive protein, and insulin resistance. It should also be noted that this is just one study which is rarely enough to be considered conclusive.
Secondary Studies
The studies below, while not primarily looking at thyroid function, did measure it while studying other effects of soy.
Studies showing no effects on thyroid hormone were:
•	54 mg/day genistein in post-menopausal women for 3 years (13) 
•	76 mg/day isoflavones in post-menopausal women for 2 years (75) 
•	10 mg/day of equol in post-menopausal women for 1 year (63) 
•	90 mg/day isoflavones on post-menopausal women for 6 months (60) 
•	65 mg/day isoflavones in men and women for 3 months (69) 
•	48 mg/day isoflavones on children for 2 months (66) 
•	62 mg isoflavones on men for 2 months (68) 
•	54 mg/day isoflavones on post-menopausal women for 7 weeks (71)
A study on soy's effects on protein synthesis by the liver showed no effect on thyroid binding globulin (TBG) after 118 mg/day isoflavones for 3 months in post-menopausal women (72).
The following studies showed minor changes in thyroid hormone but were not believed to be of physiological significance:
•	90 mg/day isoflavones in post-menopausal women for 6 months (73) 
•	132 mg/day isoflavones in post-menopausal women for 3 months (70) 
•	128 mg/day isoflavones in pre- and post-menopausal women for 3 months (61) 
•	40 mg/day isoflavones in pre-menopausal women for 1 month (74) 
•	140 g/day soybeans in female students for 1 week (65)
One study of 50 g/day soy protein in men for 4 weeks found that T4 changed from baseline, but did not differ from the placebo group (64).
Finally, one study found that 30 g/day of pickled soybeans didn't change thyroid hormone levels but caused a goiter in half the subjects.
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•	Infant Formula
•	Summary: The American Academy of Pediatrics and the National Toxicology Program considers soy formula safe for term infants. There has been one cohort study looking at the general health of adults who were fed soy formula as infants. It found no reason to be concerned about thyroid or reproductive function (95). The Beginnings Study is an ongoing study examining the effects of formula on development. It is in its early stages with findings from children only a year old, but to date no negative effects of soy have been found on growth, sex organs, or neurological development compared to children on cow's milk formula. It is best to choose a soy formula with DHA. Soy-formula is not intended for pre-term infants.
Reviews
Excerpts from Setchell et al's 1997 review paper on soy infant formulas sums up the controversy (79):
When bodyweight and milk intake are taken into account, an infant exclusively fed soy-based formulas would be exposed to a fairly constant dose [of isoflavones] throughout early life. This dose represents a 6–11 fold higher level of intake of isoflavones than the bodyweight-adjusted intake (0.7 mg/kg per day) found to cause significant modifications to the hormonal regulation of the menstrual cycle of western women.... These values are also much higher than plasma isoflavone concentrations of Japanese adults, which range from 40 to 240 ng/mL. 
Seven years later in 2004, Merritt and Jenks wrote (82): 
Largely as a result of research in animal models, concerns have been voiced regarding isoflavones in soy infant formulas in relation to nutritional adequacy, sexual development, neurobehavioral development, immune function, and thyroid disease. We discuss the available clinical evidence regarding each of these issues. Available evidence from adult human and infant populations indicates that dietary isoflavones in soy infant formulas do not adversely affect human growth, development, or reproduction.
American Academy of Pediatrics Committee on Nutrition (2008)
While the American Academy of Pediatrics (AAP) recommends not using soy formula unless cow's milk formula is contraindicated or the parents are vegan, they say that there is no reason to think that it harms development in term infants (84):
In summary, although studied by numerous investigators in various species, there is no conclusive evidence from animal, adult human, or infant populations that dietary soy isoflavones may adversely affect human development, reproduction, or endocrine function... [A]n increased incidence of feminization in male infants or an increased incidence of hypospadias in high soy-consuming populations have not been observed. 
Regarding infants with thyroid problems:
Consumption of soy products by infants with congenital hypothyroidism complicates their management, as evidenced by a prolonged increase in thyroid-stimulating hormone when compared with infants not fed soy formula; the authors of 2 studies suggested closer monitoring and a possible need for an increased dose of levothyroxine. 
The AAP does not recommend soy infant formulas for pre-term infants due to studies showing poor bone growth in pre-term infants on soy-formula compared to cow's milk formula designed for pre-term infants. There is also a concern that aluminum levels in soy formula could be a problem for infants with undeveloped kidneys. They say, "Term infants with normal renal function do not seem to be at substantial risk of developing aluminum toxicity from soy protein-based formulas."
National Toxicology Program (2009)
The National Toxicology Program's Center for the Evaluation of Risks to Human Reproduction convened an expert panel on December 16-18, 2009 to evaluate soy infant formula (85). They concluded that there is minimal concern for adverse developmental effects in infants fed soy formula.
Research
Other studies include:
•	Three case studies of infants with goiter in 1960, before soy formula was fortified with iodine (80). 
•	A 1990 retrospective case-control study showing children diagnosed with autoimmune thyroid disease were more likely than controls to have received soy formula as infants (81). 
•	A 2001 study of young men and women who had eaten soy infant formula found no reason to be concerned about thyroid or reproductive function, although the women had slightly longer duration and greater discomfort of menstrual bleeding (95). 
•	A 2008 cross-sectional study showing that female toddlers who received soy had more breast bud tissue left (93). 
•	A 2008 cross-sectional study found female girls on soy formula had a higher maturation index which the authors thought should be examined in future studies (94). 
•	A 2009 cross-sectional study found no difference in sex hormone levels in children fed soy formula (83). 
•	A 2010 study found that women who had received soy formula as infants were more likely to have non-cancerous uterine fibroids (92).
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Cognition
Summary: There have been 12 short-term clinical trials looking at the impact of soy on cognition, and all have shown soy to be helpful or neutral. A longitudinal study found tempeh to be associated with improved cognition. Three reports from longitudinal studies have associated tofu with reduced cognition in some groups, but increased cognition in another group, and neutral in others. This is likely due to confounding. Based on the research to date, there should be little concern about eating soy, including tofu, with regards to cognitive decline. 
Long-term Studies
Honolulu-Asia Aging Study (2000)
In a study of elderly Asian men living in Hawaii, food intake was collected once at baseline (1965–1967) and one more time during 1971 – 1974. Cognitive function was then measured in 1991–1993, and brain size was measured in those who had died (2).
Midlife tofu consumption by itself (controlling for no other factors) explained 2.3% of the variation in mental cognition scores. A linear regression model that included only age, education and history of a prior stroke explained 27.8% of the variation. After controlling for these three most important factors, midlife tofu consumption remained statistically significant even though it then explained only 0.8% of the variance in test scores. Despite this, the researchers state that, "In this study population, 20% to 25% of the burden of cognitive impairment appears attributable to midlife tofu consumption — an effect size of enormous public health importance..." 
Upon autopsy of those who died, smaller brain size was associated with increased tofu consumption.
In an accompanying editorial, Grodstein et al, write (41):
Clearly, these results are interesting, although must be considered preliminary; relatively few subjects consumed tofu at high levels, and the confidence intervals around the estimates of effect presented are wide, indicating the limited precision of these results... Importantly, we do not know if tofu itself was the cause of these numerous indications of accelerated brain aging or if tofu is merely a marker for some other unfavorable exposure. For example, in this population, men with higher tofu intake (and more traditional diets) likely came from poorer immigrant families and perhaps experienced more childhood privation, which may be related to their brain development and subsequent cognitive function.
In 2010, Hogervorst et al, reference this study (42):
People of low socioeconomic status were hypothesized to eat more soy (as an animal protein substitute because it is cheaper). However, low socioeconomic status in itself is associated with a faster cognitive decline and an earlier onset of dementia and could thus have mediated the association between high soy intake and low memory function.
Kame Project, King County, Washington (2000)
The Kame Project is a prospective study of Japanese Americans aged 65 years or older living in King County, WA (53). Cognitive ability was measured at the beginning and after two years. Tofu consumption was categorized as low (<1/wk), moderate (1–2/wk), and high (3+/wk). At the beginning of the study, among women taking estrogen replacement therapy, high tofu consumption was associated with lower cognitive scores. No other statistically significant differences were found at baseline, and all analyses were adjusted for age, education, and language spoken. Upon testing at two years, tofu consumption was not associated with the rate of cognitive change either among men, women, or women on estrogen replacement therapy. 
Tofu and Tempeh Study, Indonesia (2008 & 2010)
A 2008 study from Indonesia found that among people aged 52 to 98, tempeh intake was associated with slightly better memory scores (9). The authors suggested that tempeh might be good for memory because the bacteria used in the tempeh starter, Rhizopus oligosporus, produce folate which is thought to protect memory.
However, increased tofu consumption was linked to slightly worse memory scores (-0.18, p = .05). The authors state that, "According to the Departments of Public Health at the Universities of Jakarta and Yogyakarta, formaldehyde is often added to tofu (but not tempeh) to preserve its freshness. Formaldehyde can induce oxidative damage to the frontal cortex and hippocampal tissue...." As of January 2011, the Indonesian government was still trying to end the practice of adding formaldehyde to tofu (43).
In 2010, this research group published a follow-up paper (42). It was a cross-sectional study of 151 men and women (most from the previous report) over the age of 56. Both immediate and delayed recall were tested. Median and mean tempeh and tofu consumption was seven times a week, ranging from never to three times a day. Before adjusting for age, sex, and education, tempeh and tofu were associated with better immediate recall; after adjusting, the associations were no longer significant. In the group younger than 73 years, higher tofu consumption was significantly associated with better immediate recall even after the adjustments.
There are a lot of theories as to why this follow-up study had opposite findings of their first study (one being that the older people who were eating more tofu had died), but it is an indication that tofu, itself, does not cause cognitive decline.
California Seventh-day Adventists (1993)
Seventh-day Adventists (SDA), ages 65 and over who had not eaten meat in the previous 30 years were about one-third as likely to develop dementia as their regular meat-eating counterparts (58). While soy intake was not compared to dementia rates, another study (59) of California Seventh-day Adventists showed SDA vegetarians to eat an average of 3.5 servings of meat substitutes (which usually contain soy) per week compared to only 1.4 servings by their meat-eating counterparts.
Clinical Trials
There has been a plethora of short-term (lasting one week to a year) clinical trials on soy and cognitive function. Four studies found that soy had benefits compared to the placebo (44, 45, 48, 49). One study found no decline in cognitive function in the soy group whereas the placebo declined (47). Four studies found a benefit to soy but there was no placebo group (50, 54, 55, 56). Three studies found no benefit of soy (51, 52, 57). No study found the placebo group to do better than the soy group on any measurement of cognitive function.
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Conclusion
The short-term clinical trials have been very favorable towards soy and cognitive function. The one long-term study that assessed a non-tofu soy food, tempeh, found a protective effect in the first analysis, and no effect after adjustments in a follow-up.
The main concern appears to be tofu which has recently been prepared with formaldehyde in Indonesia and was a food traditionally eaten by poorer people with less education. The research can be summarized as follows:
•	The Honolulu-Asia Aging Study found tofu consumption during the 1960s and 1970s was associated with cognitive decline in the 1990s (2). 
•	An Indonesian study of older people found that tofu was associated with slightly lower memory scores, possibly due to formaldehyde in processing (9). A follow-up report found that tofu was linked with better memory scores among the younger subjects (42). 
•	The Kame Project, a study of older Japanese Americans found that at baseline, and only among women taking estrogen replacement therapy, tofu consumption was associated with lower cognitive scores. Testing again two years later, this association was no longer there (53). 
It seems safe to assume that tofu does not have an appreciable effect on cognitive function and that these associations are due to confounding variables. A study on non-Asians and tofu consumption (where it cannot be linked to lower socioeconomic status or formaldehyde) could shed more light on this subject.

Hexane
Summary: There is little evidence to determine whether the hexane residues in some processed soy meats are safe over the long term, though hexane processing can be harmful to workers and the environment. It seems prudent to buy most of your processed soy from companies that do not use hexane extraction.
Hexane is sometimes used by the soy industry to separate the oil from the protein in soybeans. The protein is then used for soy meats and other products that contain soy protein extract. This process inevitably leaves some hexane residues in the products.
The Cornucopia Institute is a public interest group that promotes organic agriculture. In November 2010, they released a report Toxic Chemicals: Banned In Organics But Common in "Natural" Food Production. The report makes a persuasive argument that hexane use is dangerous to workers and the environment (the evaluation of which is beyond the scope of this article), and for those reasons alone it seems better to use soy meats processed without hexane. Luckily, there are soy meats available that do not use hexane such as Tofurky, Field Roast, Wildwood, Amy's Kitchen, and some (though not all) Boca products (link). Foods certified as "USDA Organic" are produced without using hexane extraction.
There is not much evidence that the amount of hexane found in most veggie burgers is harmful. The U.S. Food and Drug Administration has not set an upper limit on how much hexane residue can be in foods, whereas the European Union prohibits hexane residues greater than "30 mg/kg [30 ppm] in the defatted soya products as sold to the final consumer" (118). The Cornucopia Institute found some soy ingredients to have hexane levels as high as 21 ppm, but did not provide details on the average hexane levels they found in any final food products.
More info on hexane in soyfoods:
•	Hexane in Soy Food – Berkeley Wellness | May 01, 2012 
•	Do Veggie Burgers Contain Hexane? – Shereen Jegtvig, MS | Updated Feb 07, 2014

Mineral Absorption
Summary: Eating a few servings of soy per day is unlikely to result in calcium, zinc, iron, or magnesium deficiency.
Table 2. Phytate Content of Selected Foods97				
Food	Range or Average
g/100 g			
Wheat	0.52 - 1.05			
Corn	0.62 - 1.17			
Barley	0.85 - 1.18			
Oats	0.90 - 1.42			
Peas	0.72 - 1.23			
Soybean	1.20 - 1.75			
Soy isolate	0.82			
Lupine bean	0.76 - 1.63			
Vital gluten	1.90			
Soybeans contain phytic acid, also known as phytate, which can inhibit the absorption of calcium, zinc, iron, and possibly magnesium. Many whole plant foods contain phytate, but soy has more than most. Hidvegi and Lasztity estimated the phytate content per 100 grams of food (97) in Table 2.
While phytic acid has a bad reputation, it has some benefits. In their 2002 review, Minerals and Phytic Acid Interactions: Is It a Real Problem for Human Nutrition?, Lopez et al point out that phytates can prevent lipid peroxidation, iron oxidation of colorectal tissue, and calcium-based kidney stones (98).
Calcium
Calcium Absorption
Three studies on adults (99,100, 101) have shown calcium to be absorbed from soy at rates comparable to that of cow's milk. One study on Chinese boys found calcium from soy milk to be absorbed at 43% while calcium from cow's milk was absorbed at 64% (109, see Table 3).
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Table 3. Mineral Absorption Rates in Chinese Boys109				
Food	Calcium
(%)	Zinc
(%)	Iron
(%)	
Soy milk	43.5	11.3	6.7	
Cow's milk	64.2	31.2	15.5	
Dephytinized soy milk	50.9	20.1	20.6	
Soy and Bones
Although a 2010 (3) and 2008 (4) meta-analysis each found that soy isoflavone supplements of 82 and 90 mg/day, respectively, increases bone mineral density in menopausal women, a more recent, clinical trial found little benefit from 80 or 120 mg of soy isoflavone supplements for three years (6).
There is a plethora of evidence that soy does not harm bones; including a cross-sectional study from the Chinese University of Hong Kong (2003) which found that women who ate the most soy (10 g/day of soy protein or more) had greater bone mineral density than those in the lower intake groups (104).
Show more clinical trials on soy and bone mineral density or bone markers.
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Zinc
Studies have shown that the zinc in soy is absorbed at a rate of about 10 to 20%.
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Iron
Iron from plant foods is generally not absorbed as well as iron from meat. But a type of iron in soy, ferritin iron, is absorbed at about 30% among people with low iron stores, and this is a high rate of absorption. Ferritin iron makes up a large percentage of the iron found in soybeans; up to 90% (127). Some soy foods have a decent amount of iron, including extra firm tofu (3.35 mg per 1/2 cup), edamame (1.75 mg per 1/2 cup), and soy nuts (1.7 mg per 1/4 cup). There is no reason to worry that moderate amounts of soy might cause iron deficiency.
Also note that adding vitamin C to a meal (in a dose of about 100 mg) has been shown to significantly increase absorption of the iron in plant foods in numerous studies. I found no studies on vitamin C's effect on iron absorption from soy foods in adults, but two showed that it significantly increased iron absorption from soy formula in infants (114, 115).
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Magnesium
I found no studies looking at the effect of soy on magnesium absorption. Phytates have been shown to bind magnesium, so it would be no surprise if the magnesium in soy is absorbed at a lower rate than from other foods. Leafy green vegetables, whole grains, nuts, and seeds are the best sources of magnesium and people eating such foods while adding a few servings of soy per day should not be in danger of magnesium deficiency.
Fermentation
In their 2007 review, Hotz and Gibson say that fermentation can reduce the amount of zinc and iron-binding phytates in soybeans and should, therefore, increase the amount of zinc and iron absorbed from fermented soy foods such as tempeh and miso (111).
The effects of fermenting soy foods on rates of zinc absorption have not been tested in humans, but one study from the University of the Witwatersrand, South Africa (1990) found that the iron in tempeh was absorbed better than from other soy foods, at a rate of 10 – 15%; the iron from tofu was absorbed at a range of about 3 to 8% (113). Again, absorption rates of plant iron vary greatly according to someone's current iron status and the amount of iron in the food, which can account for a large range of absorption amounts.

Feminizing Characteristics
Summary: It requires twelve servings of soy (and probably much more for most men) to have any sort of noticeable feminizing effects. While one epidemiological study raised concerns about soy and sperm quantity (14), two clinical studies have shown no effects of soy on sperm quality or quantity (15, 126).
Case Reports
In 2011, there was a case report of a 19-year old vegan male who was eating a great deal of soy foods - enough to provide 360 mg of isoflavones per day, the equivalent of about 14 servings (10). He also had type 1 diabetes. After eating this way for a year, he developed low free testosterone levels and erectile dysfunction. After ceasing the soy products (and the vegan diet), his symptoms normalized within a year. There was no reason why he needed to stop being vegan rather than just cutting way down on, or eliminating for a period, soy foods.
A 2008 case report described a 60 year old man who developed gynecomastia (the enlargement of the mammary glands in a male) after drinking 3 quarts of soymilk (the equivalent of 12 servings) a day (123). His breasts returned to normal after discontinuing the soymilk. 
Gynecomastia - Male Breasts
In contrast to the case report above, in a 2004 study, 20 men with prostate cancer were given either 450 mg (amount found in about 18 servings of soy) or 900 mg (amount found in about 36 servings of soy) of isoflavones for 84 days (124). Two of the men, who had no gynecomastia at baseline, receiving the 900 mg developed mild cases of gynecomastia. One man was taking a drug that likely increased the gynecomastia. Two men had hot flashes probably related to the isoflavones. Given the very large amounts of isoflavones they were taking, this study should allay fears of feminization in men rather than cause any sort of alarm.
Sperm
A 2008 epidemiological study found that men attending a fertility clinic had lower sperm concentrations if they ate more soy, but the amount of soy was very small (≥ .3 servings/day) and part of the difference could be explained by a higher ejaculate volume (14). Two more recent clinical trials using 62 mg/day of isoflavones for two months and 480 mg/day of isoflavones for three months found no difference in sperm count, concentration, or motility. 
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•	Review
Messina sums up the rest of the literature on soy and feminizing characteristics in men in his 2010 review (122):
In contrast to the results of some rodent studies, findings from a recently published metaanalysis and subsequently published studies show that neither isoflavone supplements nor isoflavone-rich soy affect total or free testosterone (T) levels. Similarly, there is essentially no evidence from the nine identified clinical studies that isoflavone exposure affects circulating estrogen levels in men. Clinical evidence also indicates that isoflavones have no effect on sperm or semen parameters, although only three intervention studies were identified and none were longer than 3 months in duration. Finally, findings from animal studies suggesting that isoflavones increase the risk of erectile dysfunction are not applicable to men, because of differences in isoflavone metabolism between rodents and humans and the excessively high amount of isoflavones to which the animals were exposed. The intervention data indicate that isoflavones do not exert feminizing effects on men at intake levels equal to and even considerably higher than are typical for Asian males.
Endometrium
A 2009 meta-analysis of five retrospective and two prospective studies found that participants with a higher soy intake (roughly one serving per day) had a reduced risk for endometrial cancer and ovarian cancer, when compared with lower soy intakes. Two other studies of three years in duration found that soy isoflavones in the amounts of 70, 80, and 120 mg/day did not have a negative effect on the endometrium. However, one study using 90 mg of isoflavones for five years (equivalent to 3.5 servings of soy per day) did result in cell growth (though non-cancerous) of the endometrium among some subjects. Women at risk for endometrial cancer might use caution in eating more than one serving per day of soy.
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Ovarian Function
A 2010 review by Wendy N. Jefferson of the Laboratory of Reproductive and Developmental Toxicology, National Institute of Environmental Health Sciences, summarized the literature on soy and ovarian function (117):
For the most part, the studies conducted to date suggest that a diet containing lower levels of soy, e.g. 1–2 servings of soy/d, as part of a well-balanced diet should not pose harmful effects on the function of the ovary as it relates to ovulation. These levels are similar to that found in a traditional Asian diet (10–25 mg/day isoflavones) and even up to 50 mg/day isoflavones has little impact on serum circulating levels of hormones involved in reproduction. Although the levels of phytoestrogens typically found in soy foods pose minimal risk in the adult female, the female reproductive system is dependent on hormones for proper function and phytoestrogens at very high levels can interfere with this process. 
Additionally, a 2009 meta-analysis of five retrospective and two prospective studies found that participants with a higher soy intake (roughly one serving per day) had a reduced risk for endometrial cancer and ovarian cancer, when compared with lower soy intakes (119).
Fertility
A 2014 cross-sectional study from Adventist Health Study-2 found that a higher intake of isoflavones was associated with an increased rate of never becoming pregnant and of being childless (136). Among the highest soy intake category of > 50 mg/day (average of 79 mg/day or about three servings), compared to those in the lowest intake category (average of 3.7 mg/day), there was a 15% higher rate of being childless (1.15, 1.02-1.29). This finding was adjusted for age, educational level, and marital status.
The authors did not distinguish between involuntary and voluntary childlessness.
This issue warrants further attention, but given that it is a cross-sectional study and the findings were rather weak, it seems unlikely that isoflavones cause childlessness.
Glutamate
Isolated soy protein is rumored by some to have unusually large amounts of MSG (it doesn't), and MSG, in turn, is rumored to be an excitotoxin (for practical purposes, it's not) that will destroy brain cells. I cover this topic in some blog posts at JackNorrisRD.com (link).
Hypospadias
Summary: Two studies have examined soy intake and risk of hypospadias. Neither found a statically significant risk with more soy intake. It appears that factors other than soy are the most likely the cause of hypospadias, although more studies are warranted.
Hypospadias is a male birth defect in which the opening of the urethra (the tube through which urine passes) is not located at the tip of the penis as it should be. The milder forms of hypospadias, which are by far the largest number of cases, are relatively easy to repair which usually results in a penis with normal or near-normal function and appearance, and no future problems (135).
A 2004 case-control study from the Netherlands (133) found no link between maternal soy intake and an increased risk of hypospadias. Women who had a soy protein intake of 20 g or more had the exact same risk as those eating no soy (1.0, 0.5-2.2).
A 2000 UK prospective study, of 7,928 boys born to mothers taking part in the Avon Longitudinal Study of Pregnancy and Childhood, found 51 cases of hypospadias (134). There was a trend of more soy meats and soy milk being associated with an increased risk for hypospadias, but the findings were not statistically significant, nor were the results adjusted for any confounding variables.
Two of three studies have found an increased risk of hypospadias if the mothers were vegetarian; more information can be found in the VeganHealth.org article, Hypospadias and Vegetarian Diets.
The Crucial Soy Link
By T. Colin Campbell, PhD December 20, 2010 · modified on November 16, 2015
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In view of the recent news on the health benefits of soy protein, what do we find in our China Project?
Since China is one of the leading producers and consumers of soy products in the world, their use of this food may be of special interest.
First, recall that our survey included a total of 65 mostly rural counties across the far reaches of the country, with two villages of 50 families each being surveyed in each county. Also recall that disease rates and diets varied enormously from area to area, thereby creating very distinct geographical patterns for heart disease, various cancers and so on. Because most rural Chinese rarely move to other areas and they eat mostly the same kinds of food throughout their lives, we find an almost perfect experimental setting to compare diet, lifestyle, and disease characteristics.
Although consumption of soy products was not measured independently of other legume intakes, this does not compromise our question very much because soybeans comprised, on average, about 80% of the total legumes actually consumed. In fact, the Chinese word for soybean is “tatou,” meaning “the greater bean.”
Total legume intake in China ranged from virtually nothing in a few counties to average daily intakes of 55-58 g/day for three counties (about two ounces, fresh weight). Surprisingly, average intakes across the whole of China were not as high as we had expected. We should recognize, however, that the survey included mostly rural counties where legumes have often been considered more of a luxury food than a regular staple. Thus, any cholesterol-lowering effects of soy protein itself are largely buried within the total diet effects and would be difficult to dig up.
	Dry	Cooked	
Protein	34.1 g	11 g	
Fat	17.7 g	5.7 g	
Calories	403	103	
Carbohydrate	33.5 g	10.8 g	
Crude Fiber	4.9 g	1.6 g	
Calcium	226 mg	73 mg	
Phosphorus	554 mg	179 mg	
Iron	8.4 mg	2.7 mg	
Sodium	5 mg	2 mg	
Potassium	1,677 mg	540 mg	
Vitamin A	80 IU	30 IU	
Thiamine	1.1mg	0.21 mg	
Riboflavin	0.31 mg	0.09 mg	
Niacine	2.2 mg	0.6 mg	
Source USDA
Nonetheless, here’s what the data show. When we compare the amount of legumes eaten with the “bad” kind of blood cholesterol, we find an “inverse association.” This means that as legume intake goes up, cholesterol goes down. We measured bad cholesterol in two ways, as LDL and as apolipoprotein B (a much less familiar kind of cholesterol). In the case of “apo B” cholesterol, the inverse association was highly statistically significant. We also found an inverse association between legume intake and a couple of different kinds of heart disease. Again, these associations were generally statistically significant.
In a nutshell, the data from rural China are not as discriminating for soy protein effects as were the controlled trials of other studies recently reported in the New England Journal of Medicine. The China Study, nonetheless, represents what is seen under very practical conditions. While not astounding, we did find what we expected, namely, the eating of legumes (mostly as soy) is associated with lower blood cholesterol levels and lower heart disease rates. The most remarkable feature of these data is the fact that this cholesterol-lowering association with increasing intakes of protein was observed among people whose blood cholesterol was already quite low.
Soybeans contain more than 100% of the dietary requirements of the essential amino acids lysine, methionine, and cystine, threonine, and tryptophan. They are the only beans whose proteins are considered “complete.” One cup of cooked soybeans contains as much protein as a serving of meat, fish, or poultry.