Excessive consumption of soybean milk and unexplained hepatitis

V Wiwanitkit 
 Wiwanitkit House, Bangkhae, Bangkok, Thailand

Correspondence Address:
V Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok
Thailand

Full Text

Sir,

Soybean milk is a widely ingested beverage in East and Southeast Asian countries. Although soybean milk has many health benefits, excessive consumption can cause some problems. [1] Here, the author presents a case of unexplained hepatitis which is likely due to excessive consumption of soybean milk.

The patient, a 53-year-old female, presented with unexplained elevation of serum glutamic oxaloacetic transaminase (SGOT) (levels between 108-124 U/L, normal value 0-40 U/L) and serum glutamic pyruvic transaminase (SGPT) (levels between 122-134 U/L, normal value 0-40 U/L) for three months. At first, the patient had no symptom. The identification of the liver function abnormality was due to the routine annual checkup program of the patient. This case was investigated for the hepatitis profile (hepatitis A, B and C serological markers and molecular testing), autoimmune profile (antinuclear antibody (ANA), rheumatoid factor (RF), anti-double strand DNA (Anti dSDNA), anti-Smith (Anti-Sm), anti-ribonucleoprotein (Anti-RNP), Anti Cardiolipin), heavy metal and volatile toxic substance profiles and the results showed negative results for all tests. The patient also got ultrasonographic imaging study done and no mass lesion or fatty liver could be observed. The investigation of alpha fetoprotein (AFP) showed normal level (3.47 IU/mL, normal value 0-5.8). This patient had no underlying illness and denied history of any medical use, over-the-counter drug, supplementation and herb. This case was consulted for assessment of possible cause of hepatitis. The complete history-taking and nutritional assessment was done with the help of a clinical nutritionist. An important observation was the history of regular daily intake of soybean milk about 2.5-3 liters per day for one year. This behavior was suspected to be a cause of the unexplained hepatitis in this case, hence, the patient was told to stop intake of soybean milk. Focusing on therapeutic management, soybean milk intake was restricted and there was no other medication. The follow-up visit at one month showed a dramatic decrease in the level of SGOT (28 U/L) and SGPT (34 U/L) to normal level (results of other liver function tests were within normal limits). Hence, soybean milk withdrawal was associated with amelioration of biochemical changes. Ruling out other possible causes of hepatitis, and significant improvement after cessation, the excessive soybean milk intake was a probable cause (based on Naranjo scaling) of unexplained hepatitis. Indeed, drinking soybean milk is good for health. However, this does not mean excessive drinking of soybean milk can be acceptable. The adverse effect of receipt of excessive isoflavone from soybean product has been mentioned for a few years. In a Japanese study, [2] an excessive consumption contributed to subsequent risk of hepatocellular carcinoma. Induction of hepatitis is also documented. [3] The problem of soybean product ingestion and hepatitis is rarely mentioned. This might be because excessive intake is not common. However, in this case report, extreme excessive intake of soybean milk for a long time is believed to be the cause of unexplained hepatitis. Cessation of intake and recovery of liver enzymes were the clues for diagnosis of the condition. Actually, the isoflavone in the soybean is a natural product that can cause harm to the liver. [4] Focusing on the mechanism, the soypeptides can affect many biological processes such as LDL-R transcription in the human liver cell [5] and excessive stimulation can be cytopathic. However, the exact molecular mechanism of soy isoflavone is very complex and interindividual variation results from both genetic underlying and intertinal microflora. [6]

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