Foods That Fight Cancer™
Tofu, tempeh, edamame, soymilk and miso are a few of the soy foods people around the world enjoy every day. Soy is one of the few plant foods with all the amino acids your body needs to make protein. You may see claims on food packages linking soy protein to lower risk of coronary heart disease. Because soy contains estrogen-like compounds, there was fear that soy may raise risk of hormone-related cancers. Evidence shows this is not true. Soy’s possible effects on health is an active area of research.
What's in Soy?
Soy foods are good sources of protein, and many are also good sources of fiber, potassium, magnesium, copper and manganese. Soy foods contain significant iron, but it's not clear how well our bodies absorb it. Soymilk, tofu made with calcium, and soybeans are good sources of calcium. Soy is also a good source of polyunsaturated fat, both the omega-6 (linoleic acid) and omega-3 (alpha-linolenic) types.
Soy contains a variety of phytochemicals and active compounds:
What's a serving?
How do almond and soy milks compare nutritionally to cow's milk? - From AICR HealthTalk
Meatless Meals - from Reduce Your Cancer Risk: Diet
How are edamame served? - From AICR HealthTalk
Full Glossary for Foods That Fight Cancer
The Cancer Research
Soy foods contain several key nutrients and phytochemicals studied for their cancer prevention properties. Many soy foods also contain dietary fiber, which links to lower risk of colorectal cancer. Soy foods contain isoflavones, which are phytoestrogens that in some ways mimic the action of estrogen. Because high levels of estrogen link to increased breast cancer risk, there was a fear that soy foods – and its isoflavones – may increase risk. Yet overall, human studies show soy foods do not increase risk and in some cases, research suggests they may lower it.
What Current Evidence Shows: AICR/WCRF expert report and its Continuous Updates (CUP)
|Soybeans, soy nuts and edamame contain fiber. After a systematic review of the global scientific literature, AICR/WCRF weighed the strength of the evidence linking these factors to lower risk for several cancers.|
|Source: Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective and the 2011 Continuous Update Project (CUP): Colorectal Cancer. *including supplements|
|Diets high in:||CONVINCINGLY lower risk of the following cancers:|
|Foods containing dietary fiber||Colorectum|
”These findings are great news for women who want to use soy as a source of protein while cutting back on animal protein such as red and processed meat for better health and lower cancer risk.”
—Bette J. Caan, DrPH
Open Areas of Investigation: Laboratory Research
The majority of laboratory research involving soy and cancer risk has involved soy’s isoflavones genistein and daidzein.
In cell and animal studies, genistein, daidzein and other soy compounds have slowed cancer cell growth and prevented tumor formation. In lab studies, soy and genistein have decreased tumor growth and increase self-destruction of prostate cancer. Soy and its phytochemicals appear to prevent cancer development by reducing inflammation, and inhibiting activation of proteins that promote cell growth.
Some early studies in rodents suggested that genistein increased growth of estrogen receptor-positive (ER+) breast cancer cells, and it promoted breast cancer growth.
Studies show that rats and mice metabolize phytoestrogens such as genistein differently than humans (and other non-human primates). For soy and its components, the relevance of animal studies to humans remains unclear. Rodent metabolism leads to much higher levels of the active form of isoflavones compared to humans. Therefore, many researchers now say that the effects on breast cancer growth seen in rodent studies may be linked to their far higher blood levels of isoflavones in active form, and would not be expected to occur in humans.
Also, recent cell research shows that soy isoflavones such as genistein are much more likely to bind to a particular type of estrogen receptor in humans called ER-beta, rather than to ER-alpha. When activated, ER-alpha receptors appear to promote cell growth.10 Emerging evidence suggests ER-beta receptors act as a potential tumor suppressor that inhibits cell growth. ER-beta receptors are found in the breast and other tissues throughout the body. In some tissues, such as bone, ER-beta receptors may stimulate healthful non-reproductive effects.
Open Areas of Investigation: Human Studies
In general, Americans do not eat large amounts of soy, which makes it challenging for US observational studies to compare how highest versus lowest intake links to cancer risk. The majority of population studies involving soy are conducted in Asia, where soy is a dietary staple. Even so, across populations, studies now point to soy possibly protecting against some cancers and overall, presenting no increased risk.
Population studies link soy consumption with lower breast cancer risk in Asia, where women consume moderate amounts of soy throughout their life. A moderate amount is approximately one to two servings a day. Research now suggests that hormone-related protective effect of soy against breast cancer relates to soy consumption in childhood, adolescence, and throughout puberty. Soy also may affect cancer risk in some populations more than others, due to differences in genetics and gut bacteria that metabolize soy compounds into their active form.
AICR/WCRF’s latest continous update report on breast cancer (2010) said the evidence is suggestive, but too inconsistent to conclude that soy reduces risk of breast cancer. Beyond breast cancer, AICR/WCRF’s 2007 expert report concluded there was only limited evidence linking soy or total isoflavone consumption to lower risk of cancers of the prostate and stomach. A handful of studies link soy or total isoflavone consumption with lower risk of lung and colon cancers.
Clinical Trials: Among women without cancer, several randomized controlled trials have studied consuming soy protein powder or soy isoflavone supplements for six months to two years. One study focused on breast cancer patients; see below 'What about cancer survivors.' The amounts of isoflavones consumed in the studies are equal to or higher than what Asian women typically eat – one to two servings a day.
Overall, the studies among cancer-free women show no difference between the women who consume or do not consume isoflavones in hormone levels or breast density, a marker of increased breast cancer risk.
There is some research that suggests how a woman metabolizes isoflavones may play a role in lowering breast cancer risk. About a quarter of the US population has gut bacteria that metabolizes soy isoflavones into a compound called equol. In one clinical trial, for example, women who metabolized isoflavones into equol after eating soy appeared to benefit more than women who do not produce much equol. In the equol-producing women, eating soy shifted the body’s production of estrogen to more favor another form of the hormone. Lab studies suggest that this other form does not promote breast cancer growth, but research on this is ongoing.
This also fits with limited population studies suggesting that part of why people differ in the benefits they get from soy involves how much equol they produce when they consume it.
What about cancer survivors?
Breast Cancer Survivors: Overall, the seven recent epidemiologic studies examining soy consumption among breast cancer survivors – in six population studies and one combined analyis – show that consuming moderate amounts of soy foods does not increase a woman’s risk for poorer outcomes. The amounts classified as moderate are comparable to what Asian women consume. Some of the studies point to a potential benefit among women receiving certain treatments or with certain tumor characteristics.
Among Asians, postmenopausal women who ate the most soy foods – about two to three servings a day –had the lowest risk of recurrence or death compared to women who ate the least, less than a few serving a week. These findings were also seen in studies among predominantly Caucasian women who consumed soy at levels comparable to the average Asian.
In the largest study to date, a pooled analysis of studies that included almost 10,000 breast cancer patients, consuming at least 10 milligrams isoflavones (mg) daily linked to a 25 percent decrease in breast cancer recurrence. This effect was seen among both women from the United States and Asia, and was most evident in survivors of ER-negative cancer and those with ER-positive cancer taking tamoxifen.
For soy supplements, one 2014 randomized controlled trial studied the effects of soy powder protein among women diagnosed with breast cancer, before their surgery. The study showed that soy supplementation alters the expression of genes associated with promoting breast cancer. With consumption only lasting from 7 to 30 days and many unknowns about other gene changes, the clinical significance of the study is unclear. Amounts of isoflavones consumed were above those recognized as safe – which is 100 mg/day – underscoring the point that more is not necessarily better. Studies supporting benefits of a moderate level should not be used to support use of much higher amounts of a nutrient or compound.
Overall, these population studies do not show any harmful interactions between soy foods and anti-estrogen medications. A small number of studies even suggest soy foods may be most protective for women who take tamoxifen or an aromatase inhibitor, but more research is needed.
Prostate Cancer Survivors: Increasing levels of prostate-specific antigens (PSA) may indicate signs of prostate cancer development. Overall, trials have hinted that soy foods may lower PSA levels and may benefit prostate cancer survivors; none of the studies have demonstrated harm.
In several clinical trials of men with various stages of prostate cancer who were experiencing increases in PSA, the rate of PSA rise tended to slow in those consuming soy milk or isolated soy isoflavones. The isoflavone intake among these men ranged from 30 to 200 mg of isoflavones daily for six to 12 months. This intake correlated from the typical amount to double that of the typical Asian diet. This effect was stronger in some men than others, and it was not clear whether genetics and/or differences in metabolism explain these findings.
One trial using higher dosage of isoflavones showed no effect on PSA levels. And in another clinical trial, a soy protein containing isoflavones was not effective at decreasing the inflammatory or metabolic changes in prostate cancer survivors due to androgen deprivation treatment. However, 200 mg of isoflavone supplements daily during radiation therapy for prostate cancer decreased side effects of treatment, including decreased sexual function, leaky bladder and diarrhea.
Thanks to our expert reviewers:
Bette J. Caan, DrPH, Senior Research Scientist, Kaiser Permanente
Suzanne Dixon, MPH, MS, RD, The Health Geek, LLC
Mark Messina, PhD, MS, Nutrition Matters, Inc.
In the Kitchen
- You can find dry soybeans in supermarkets and natural food stores in bags or bulk bins.
- Green soybeans or edamame are available fresh in their pods and in the freezer section in pods or shelled, raw or pre-cooked.
- Tofu comes in different consistencies: extra firm to soft. Firm is best for stir-frying or grilling, while soft tofu works best in dishes like lasagna. Some tofu is high in calcium, depending on how it's made. Check the nutrition facts label.
- Tempeh, made from cooked and slightly fermented soybeans, is high in protein and has a nutty flavor. You can find it in your supermarket's refrigerated or frozen sections.
- Soymilk is naturally a good source of protein; if you are subsituting for milk, check the label to make sure the soymilk is fortified with calcium and vitamins D and B-12. Flavored varieties typically contain added sugar.
- Other soy foods you might enjoy include soy yogurt and cheese as substitutes for dairy, roasted soy nuts as a snack, soy nut butter (use like peanut butter) and soy flour for baking.
- Miso is a paste made from fermented soybeans and a grain like rice or barley. Its salty, savory flavor makes miso a popular base for soups.
- If you purchase the boxed shelf-stable tofu, once opened you need to refrigerate it. Keep refrigerated tofu in a container covered with water, and change the water every day or two to keep tofu fresh for up to a week. Check expiration dates.
- In the refrigerator, soymilk keeps five to seven days, tempeh up to ten days and edamame about two days. Frozen edamame, tofu and tempeh last for several months.
- Keep soy nuts in a closed container in a cool, dry place up to a year.
- Miso will keep in the refrigerator for several months.
- Tofu can be stir-fried, grilled, added to stews and soups, and used in mixed dishes like lasagna.
- Add tempeh to chili and pasta sauce or grill a slice for a sandwich.
- Try edamame in soup, stir-fries and salads, or munch on it as a snack.
- Silken tofu makes the smoothest salad dressing and smoothies.
- Use miso in soups, sauces and in marinades for meats and fish. Keep in mind it is high in sodium.
Kale, Poblano and Baked Tofu Burrito
- 1 large (8-ounce) yellow-fleshed potato, peeled
- 3/4 cup water
- 4 tsp. olive oil
- 1 Spanish onion, cut into 1/2-inch slices
- 1 garlic clove, finely chopped
- 1 tsp. dried oregano
- 2 cups steamed chopped kale
- 2 roasted, jarred red peppers, cut into 1/2-inch strips
- 4 oz. baked tofu, cut into 1/2-inch strips
- Salt and freshly ground black pepper, to taste
- 6 (9-inch) whole-wheat tortillas
Cut the potato crosswise into 1/2-inch slices. Stack 3 to 4 slices at a time, and cut them into 1/2-inch wide sticks. Place potato in a saucepan with water. Cover, bring to a boil, reduce the heat, and cook until tender, about 15 minutes. Drain and set aside.
In a medium skillet, heat oil over medium-high heat. Sauté onion slices until golden brown, about 8 minutes. Add garlic, oregano, kale and red pepper strips. Cook, stirring often, until mixture is heated through, about 5 minutes. Mix in potatoes and tofu. Season to taste with salt and pepper. Remove pan from the heat.
Heat tortillas, one at a time, in a dry skillet or 350 degree oven to soften them, about 1 minute each. Arrange 1 cup of the hot filling down the center of each tortilla, roll, and serve.
Makes 6 servings.
Per serving: 290 calories, 7 g total fat (1.5 g saturated fat), 46 g carbohydrate, 11 g protein, 7 g dietary fiber, 490 mg sodium.
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Frequently Asked Questions (FAQ)
Q: I know calcium is added to some soy foods. Does calcium increase or lower risk for cancer?
A: AICR/WCRF's latest report from its Continuous Update Project (CUP) concluded that diets high in calcium decrease risk for colorectal cancer. Studies measured calcium from dietary sources and/or supplements, and all pointed toward a protective effect. This conclusion is based on evidence derived from studies using supplements at a dose of 1200 milligrams/day.
The evidence is also strong that milk protects against colorectal cancer, probably in part due to its calcium content, although other compounds in milk may play a role.
The AICR/WCRF expert report found that diets high in calcium increase risk for prostate cancer. Studies included both foods naturally containing calcium and those fortified with calcium. However, it is important to note that increased prostate cancer risk occurred at high calcium intakes: 1,500 mg/day or more. Men in the United States have an average intake of about 800 to 1150 mg of dietary calcium per day. One cup of milk or fortified soymilk has about 300 mg calcium; 1/2 cup of tofu made with calcium sulfate contains 150 to 250 mg.
Q: Are all soy foods high in calcium?
A: Soy is not naturally rich in calcium but some soy foods, such as soymilk, soy yogurt and soy "cheese" are often fortified with calcium. Tofu contains high amounts of calcium if made with calcium sulfate, one of several substances used to coagulate soymilk into a solid form. Check the nutrition facts panel on the package and if the Daily Value (DV) of calcium is at least 20% it is considered an excellent source.
Q: What is considered a moderate amount of soy?
A: Moderate consumption is 1 to 2 standard servings daily of whole soy foods. Examples of standard serving sizes are 1/3 cup tofu, 1 cup milk soy milk, 1/2 cup edamame and 1 oz. soy nuts. (One serving averages about 7 grams of protein and 25 mg isoflavones.) Studies have demonstrated up to 3 servings a day does not link to increased breast cancer risk.
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- Maskarinec G, Verheus M, Steinberg FM, Amato P, Cramer MK, Lewis RD, Murray MJ, Young RL, Wong WW. Various doses of soy isoflavones do not modify mammographic density in postmenopausal women. J Nutr. 2009 May;139(5):981-6.
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- Nettleton JA, Greany KA, Thomas W, Wangen KE, Adlercreutz H, Kurzer MS. The effect of soy consumption on the urinary 2:16-hydroxyestrone ratio in postmenopausal women depends on equol production status but is not influenced by probiotic consumption. J Nutr. 2005 Mar;135(3):603-8.
- Shu, X.O., et al., Soy food intake and breast cancer survival. JAMA : the journal of the American Medical Association, 2009. 302(22): p. 2437-43.
- Caan, B.J., et al., Soy food consumption and breast cancer prognosis. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2011. 20(5): p. 854-8.
- Guha, N., et al., Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study. Breast cancer research and treatment, 2009. 118(2): p. 395-405.
- Nechuta SJ, Caan BJ, Chen WY, Lu W, Chen Z, Kwan ML, Flatt SW, Zheng Y, Zheng W, Pierce JP, Shu XO. Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. Am J Clin Nutr. 2012 Jul;96(1):123-32.
- Woo HD, Park KS, Ro J, Kim J. Differential influence of dietary soy intake on the risk of breast cancer recurrence related to HER2 status. Nutr Cancer 2012;64(2):198-205.
- Kang, X., et al., Effect of soy isoflavones on breast cancer recurrence and death for patients receiving adjuvant endocrine therapy. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2010. 182(17): p. 1857-62.
- Zhang YF, Kang HB, Li BL, Zhang RM. Positive effects of soy isoflavone food on survival of breast cancer patients in china. Asian Pac J Cancer Prev 2012;13(2):479-82.
- Pendleton JM, Tan WW, Anai S, Chang M, Hou W, Shiverick KT, Rosser CJ. Phase II trial of isoflavone in prostate-specific antigen recurrent prostate cancer after previous local therapy. BMC Cancer. 2008 May 11;8:132.
- Hussain M, Banerjee M, Sarkar FH, Djuric Z, Pollak MN, Doerge D, Fontana J, Chinni S, Davis J, Forman J, Wood DP, Kucuk O. Soy isoflavones in the treatment of prostate cancer. Nutr Cancer 2003, 47:111.
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- deVere White RW, Tsodikov A, Stapp EC, Soares SE, Fujii H, Hackman RM. Effects of a high dose, aglycone-rich soy extract on prostate-specific antigen and serum isoflavone concentrations in men with localized prostate cancer. Nutr Cancer. 2010;62(8):1036-43.
- Napora JK, Short RG, Muller DC, Carlson OD, Odetunde JO, Xu X, Carducci M, Travison TG, Maggio M, Egan JM, Basaria S. High-dose isoflavones do not improve metabolic and inflammatory parameters in androgen-deprived men with prostate cancer. J Androl. 2011 Jan-Feb;32(1):40-8.
- Ahmad IU, Forman JD, Sarkar FH, Hillman GG, Heath E, Vaishampayan U, Cher ML, Andic F, Rossi PJ, Kucuk O. Soy isoflavones in conjunction with radiation therapy in patients with prostate cancer. Nutr Cancer. 2010;62(7):996-1000.
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- USDA Nutrient Data Laboratory. "Nutrient data for 16139, Soymilk, original and vanilla, with added calcium, vitamins A and D" http://ndb.nal.usda.gov/ndb/foods/show/4751?fg=&man=&lfacet=&format=Full&count=&max=25&offset=&sort=&qlookup=soymilk
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