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Interesting Article On Soy Intolerance

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Soy Intolerance Full Article

History: The typical presentation is that of an infant who develops atopic dermatitis or cow milk protein intolerance, which resolves with substitution of a soy formula but recurs 1 or 2 weeks later. Parents may report a recrudescence of dermatitis or GI symptoms. Usually, the infant presents with watery diarrhea and vomiting.

Soy protein intolerance may cause different clinical syndromes, both IgE- and non–IgE-mediated. These reactions include the following:


Urticaria or angioedema


Anaphylaxis (rare)

Atopic dermatitis

Enterocolitis syndrome

Intestinal atrophy (malabsorption syndrome)

Eosinophilic gastroenteritis

Allergic proctocolitis

In susceptible individuals, the ingestion of soy proteins may cause the following:

Protracted diarrhea

Carbohydrate intolerance

Failure to thrive

Some children present with atopic dermatitis as a major symptom; however, most patients present with profuse vomiting and watery diarrhea.

The symptoms usually begin within 2 weeks of the infant's first feeding with soy-derived milk.

Sometimes mucus can be present in the stools, but blood is rarely noted.

Even if frank manifestations of colitis are absent, inflammatory changes in the colonic mucosa are frequently encountered.

The infant is usually dehydrated, and sometimes signs of malabsorption appear.

Small-bowel atrophy has been documented in different studies.

The degree of villous atrophy may be similar to that of celiac disease.

The mucosal damage causes malabsorption, hypoalbuminemia, and failure to thrive.

Some infants can present because of red blood mixed in stools. These infants usually appear healthy, and hematochezia is the only symptom.

Physical: The physical examination findings depend on the clinical picture and the duration of symptoms.

The most frequent presentation is enterocolitis syndrome; therefore, the infant appears dehydrated, with weight loss and sunken eyes.

In case of proctocolitis, the infant usually appears healthy and has normal weight gain.

In the less frequent case of soy-induced enteropathy, the infant has a low weight-to-length ratio and usually presents with dystrophia.

The signs and symptoms are related to the degree of the malnutrition. For example, edema is related to hypoalbuminemia; dermatitis enteropathica, to low zinc level; and rickets, to vitamin D deficiency.

Causes: All soybean proteins and foods currently available for human consumption contain significant amounts of the isoflavones daidzein and genistein, either as the unconjugate form or as different types of glycoside conjugates.

The isoflavones have structural homology to steroidal estrogens; therefore, they are considered to be phytoestrogens, but little is known about their biological activity.

Unquestionably, isoflavone ingestion can elicit biological effects; however, isoflavones and their metabolites have biological properties that are quite separate from classic estrogen action.

Genistein is a potent inhibitor of tyrosine kinases and can interfere with signal transduction pathways.

The threshold intake of dietary estrogens necessary to achieve a biological effect in healthy adults appears to be 30-50 mg/d.

In soy flours and concentrates, isoflavone concentrations are relatively high (0.5-3 mg/g). In soy milk and soy infant formulas, the concentration of isoflavones is lower (0.3-0.5 mg/g), but it is 10,000-fold higher than the concentration found in breast milk. Moreover, the volume intake of these products is sufficient to account for a significantly high dietary intake of isoflavones.

Infants fed soy-based formulas have plasma concentrations of isoflavones that are 3000- to 22,000-fold higher than plasma concentrations of estradiol.

Even if these substances have a weak estrogenic activity compared with estradiol, they could have adverse effects; however, the concerns about the adverse role of phytoestrogens in the first months of life are exclusively theoretical. At this time, the very limited available evidence from adult and infant populations indicates that dietary isoflavones in soy infant formulas do not adversely affect human growth, development, or reproduction.

The results of a study that enrolled 48 children (mean age, 37 mo; range, 7-96 mo) suggest that long-term feeding with SPFs in early life does not produce estrogenlike hormonal effects.


Gastroesophageal Reflux

Ulcerative Colitis

Other Problems to be Considered:

Gastrointestinal bleeding

Celiac disease

Malabsorption syndrome

Infectious colitis


Cow milk protein intolerance

Autoimmune enteropathy

Intractable diarrhea of infancy

Intestinal infections


Intestinal infections

Cow milk protein intolerance

Inflammatory Bowel Disease


Anal Fistulas and Fissures

Meckel Diverticulum

Intestinal duplication

Intestinal hemangiomas

Intestinal infections

Cow milk protein intolerance

Inflammatory Bowel Disease

Other Tests:

Soy-induced GI symptoms are usually not IgE-mediated; therefore, both skin tests and determination of specific IgE in serum have a low diagnostic value.

RAST appears to be of poor predictive value. Many children with positive results do not react to challenge tests.

Prick tests have little predictive value. The acidic subunits of glycinin and beta-conglycinin appear to be present in reduced amounts or absent in some commercial soybean skin test extracts tested by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. As a consequence, these commercial extracts are less sensitive than extracts of soy flour.

The challenge test with soy proteins, after an elimination diet, is the only reliable method of evaluating soy protein intolerance.


Endoscopy: During the workup for differential diagnoses, upper or lower GI endoscopies are often performed in patients with soy protein intolerance. Findings, however, are nonspecific, most commonly minimal, and, at times, even completely unremarkable. Accordingly, and because of the transient nature of the disorder, endoscopies are not considered essential.


Macroscopically, only minimal erythematous changes may be observed.

Microscopically, any area (eg, lower esophagus, gastric body, antrum, duodenum) may or may not show signs of acute inflammation.

In a minority of patients, an infiltrate of eosinophils is observed.

When the clinical presentation is that of a malabsorption syndrome, the duodenal mucosa may have changes (eg, partial villous atrophy, crypt hyperplasia) indistinguishable from those of celiac disease.


Macroscopically, changes may vary from minimal erythematous segments, most commonly diffusely involving the distal colon, to severe inflammation with bleeding ulcers and loss of vascular markings.

Microscopically, nonspecific acute inflammatory changes are observed, typically indistinguishable from infectious colitis. Rarely, eosinophils predominate in the lamina propria.

I found this interesting. I am intolerant to soy. I posted a different article on soy allergy in the OMG I might be on to something page 402 or 403 I think. Not before page 400 for those interested in that.


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Thanks, Andrea! I appreciate it. Hope you are having a great night.



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    • I have seen articles linking celiac to Barretts and esophagitis.  I've actually been subtly hinting to my boyfriend to get tested for celiac as well because he has some strange Autoimmune arthritis as well as Barrett's  and some white spots on brain MRI Not MS). One of the articles I read on Celiac and Barrett's actually suggested that most of the patient did not have actual acid reflux symptoms. Not sure if you ever did antibody testing for celiac, but sounds like you certainly want to avoid gluten. 
    • Ahh good point! She is 13 and has been miserable for over two years. It started with chronic hives. We have been to a dermatologist, and a allergist and they brushed it off to her seasonal allergies and now she has joint pain,bloating,constipation,fatigue,headaches just all around miserable. I just want answers quick. she is getting depressed and says she hates her life cause she doesn't think anyone believes her. It's heart breaking . I hope we get answer soon. Thanks for the advice I will keep her on gluten. She is just miserable and I figured the sooner she is off gluten the sooner she will feel better. 
    • Welllllllll, in this particular case it would be best to keep her on gluten until the results come back. The reason I say this is b/c this GI seems whacky. There's a chance you may need to go to a different GI & have the endoscopy redone. I was going to say get a new GI but since the endoscopy is on Monday then I would go forth with it rather than waiting the time it would take to get a new GI & schedule an endoscopy. This GI seems set that it's not celiac & when they get that in their brain it's usually pretty darn hard for them to admit they were wrong. My concern is that she won't take enough biopsies from the right places b/c she's either dumb about how many & where or letting her personal (already formed) opinion influence what she will do. The problem is that you can't be there in the OR with them standing on the GI's shoulders making her do the right thing. Not knowing your daughters age, the other concern is that there may not be "enough" damage just yet, it may be patchy, etc..... that with the mindset this doc has, she will poo poo the dx.  Let me say that it would be a travesty & wholly awful IF you had to put your daughter through another endoscopy but we know how very important it is for her to have an official, dyed in the wool dx. So I'm just trying to think down the line & prevent problems before they come up. I mean, this doc may not even take any biopsies. That sounds insane I realize, but really, it happens more often than you would think. I can't tell you the number of times we've had people come on here after having an endoscopy for celiac where the doc didn't take any biopsies b/c the doc is so stupid as to think they can see the damage & doesn't realize there MUST be biopsies! If you take her off gluten & heaven forbid, you have to end up putting her back on it to get further testing then chances are she's going to get much, much sicker when she's put back on gluten. That most often happens with us and I'm talking about radically sick. See, I'm basing all my thinking on the fact that despite ALL the positive celiac blood work, this dimwit doc doesn't think it's celiac & instead it's all related to the constipation. That is just so far out there, it's NUTS! She's flying in the face of hard evidence! Every test you listed was positive. I can't even begin to understand how this GI comes to her insane conclusion. THAT'S why I am so concerned. 
    • Thanks for your reply. That's what my husband and I thought too. She has a ton of symptoms that's fit celiac. Also I was going to start her gluten free diet after her biopsy on Monday cause the dr said the results take two weeks. Is there a reason I should keep her eating gluten until we get the results? Thanks for your help.
    • In reflex testing they look at a result and decide if the next test is needed.  Another example, some labs only do EMA if the Ttg is positive.
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