The soymilk diet: A previously unknown etiology of acute pancreatitis

Published:January 27, 2021DOI:


      We present a case of daily, large ingestions of soymilk that likely led to acute pancreatitis. Soybean contains trypsin inhibitor that when ingested will reduce the activity of trypsin in the intestine. A decrease in intestinal proteolytic activity removes the negative feedback on the pancreatic acinar cells, leading to an inappropriate increase in intrapancreatic trypsin secretion. When trypsin activation exceeds the capacity of pancreatic secretory trypsin inhibitor, the subsequent cascade of events can lead to acute pancreatitis.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hirota M.
        • Ohmuraya M.
        • Baba H.
        The role of trypsin, trypsin inhibitor, and trypsin receptor in the onset and aggravation of pancreatitis.
        J Gastroenterol. 2006; 41: 832-836
        • Hirota M.
        • Ohmuraya M.
        • Hashimoto D.
        • et al.
        Roles of autophagy and pancreatic secretory trypsin inhibitor in trypsinogen activation in acute pancreatitis.
        Pancreas. 2020; 49: 493-497
        • Gumbmann M.R.
        Protease inhibitors: physiological properties and nutritional significance.
        in: Rackis J.J. Ory R.L. Antinutrients and Natural Toxicants in Foods. Food and Nutrition Press, Westport, CT1982: 203
        • Yanatori Y.
        • Fujita T.
        Hypertrophy and hyperplasia in the endocrine and exocrine pancreas of rats fed soybean trypsin inhibitor or repeatedly injected with pancreozymin.
        Arch Histol Jpn. 1976; 39: 67-78
        • Nitsan Z.
        • Liener I.E.
        Enzymic activities in the pancreas, digestive tract and feces of rats fed raw or heated soy flour.
        J Nutr. 1976; 106: 300-305
        • Liener I.E.
        • Goodale R.L.
        • Deshmukh A.
        • et al.
        Effect of a trypsin inhibitor from soybeans (Bowman-Birk) on the secretory activity of the human pancreas.
        Gastroenterology. 1988; 94: 419-427
        • Reseland J.E.
        • Holm H.
        • Jacobsen M.B.
        • et al.
        Proteinase inhibitors induce selective stimulation of human trypsin and chymotrypsin secretion.
        J Nutr. 1996; 126: 634-642
        • Green G.M.
        • Lyman R.L.
        Feedback regulation of pancreatic enzyme secretion as a mechanism for trypsin inhibitor-induced hypersecretion in rats.
        Proc Soc Exp Biol Med. 1972; 140: 6-12