DEAR DR. ROACH: Having been advised by oncologists to avoid all soy products in our diet (and taking an aromatase inhibitor to reduce the amount of estrogen produced by our bodies), several other estrogen receptor positive breast cancer patients and I have the following questions: How do phytoestrogens compare with estrogens produced by the body? Is soy the only food to avoid, or do other foods such as beans, nuts or coffee present a danger? Are all forms of soy equally detrimental? They seem to be everywhere (soy lecithin, soybean oil, soy protein, soy sauce, etc.). — C.S.

ANSWER: Soy protein contains isoflavones, which act as weak estrogens in the body. Some studies have shown no adverse effects on breast cancer patients taking in large amounts of soy protein; however, you should continue to follow the advice of your oncologists. It’s possible that by taking in enough soy protein, you can get an elevated estrogen blood level. High blood estrogen levels are of concern in women with estrogen receptor positive (ER+) breast cancers, since the estrogen causes the cancers to grow.

Soy phytoestrogens are unique to soy: nuts and coffee do not have them. Similarly, since it’s the soy protein that is at issue, soy lecithin, a fat emulsifier, is not a problem. Soybean oil and soy sauce contain no protein and are also not a concern.

Questions about breast cancer and its treatment are found in the booklet on that subject. To obtain a copy, write: Dr. Roach — No. 1101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I am 82 years old and have never had chickenpox. My physician wants me to get the chickenpox vaccine and then the shingles shot. I took my prescription to the health department, which is where I was supposed to get the chickenpox vaccine, but the nurses were reluctant to give it. Someone from disease control was supposed to call me, but so far I haven’t heard from them. My question is, if I haven’t had chickenpox, why do I need the vaccine just to take the shingles shot?

ANSWER: Everybody over 60 should have the vaccine for shingles, whether or not they have had chickenpox or shingles. In fact, the vaccine for shingles uses the same strain as the vaccine for chicken pox — but the shingles vaccine is at least 14 times more potent. The American Council on Immunization Practices recommends just the shingles vaccine for people who have never had chickenpox. Just get the shingles vaccine.

DEAR DR. ROACH: I occasionally attend an aquatics class, and after we’re finished, everyone wants to sit in a hot tub except me. One time the instructor finished the class in the hot tub. I was not happy. They are so hot it takes me 10 to 15 minutes to get into them, and sometimes too hot to get in, period. I’d like to know what’s so great about them. Also, are saunas really good for a person’s health? — H.W.

ANSWER: Hot tubs tend to relax muscles and that, combined with the buoyancy taking weight off of joints, can help some people with arthritis. Hot temperatures, especially before bedtime, also can help people sleep better, so saunas and hot tubs can help with insomnia. However, every person has a different tolerance to temperature, and you shouldn’t use hot tubs or saunas if you’re not comfortable. Talk to the aquatics instructor.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters or mail questions to P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

(c) 2013 North America Syndicate Inc.

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