Different Effects of Cholestyramine on Postprandial Secretions of Cholecystokinin and Peptide YY in Women with Bulimia Nervosa

Abstract

Objective: Patients with bulimia nervosa (BN) are reported to have decreased postprandial levels of cholecystokinin (CCK) and peptide YY (PYY). Fatty nutrients are the most powerful stimulus for releasing these peptides. Cholestyramine is an anion exchanger which adsorbs bile salts and reduces the digestion of lipids, affecting the secretion of both CCK and PYY. To further characterise the physiology of these peptides in BN, we aimed to investigate the effects of cholestyramine (12 g, per os) or placebo administered with a high-fat meal on CCK and PYY secretions in bulimic versus healthy women. Results: Postprandial CCK levels significantly increased in both healthy and bulimic women after placebo + the high-fat meal, without any significant difference between the two groups. Cholestyramine administration significantly increased postprandial CCK responses in both healthy and bulimic women; however, significantly lower CCK levels were observed in BN. Postprandial PYY levels significantly increased after placebo administration in healthy women after the high-fat meal, whereas no significant changes were found in bulimic women. Cholestyramine, administered with the high-fat meal, significantly reduced postprandial PYY response in healthy women, but not in bulimic women. Finally, there was a negative correlation of the area under the curve with respect to the increase of PYY (after placebo administration) with binge frequency in the bulimic women. Conclusion: In BN an altered postprandial secretion of CCK may be evidenced when cholestyramine is combined with a high-fat meal. Instead, the postprandial secretion of PYY is significantly blunted and not affected by cholestyramine administration.

Disturbance of gut satiety peptide in purging disorder

“…PYY predicted increased fullness, gastrointestinal distress, and urge to vomit. Prior studies of BN and BNp employing a similar test meal have found either lower (Kojima et al, ; Monteleone et al, ; Rigamonti et al, ) or no significant alteration in postprandial PYY response compared to healthy controls (Devlin et al, ), suggesting that exaggerated PYY response distinguishes PD from BNp. This is the first study to identify a specific biological dysregulation in PD.…”

“…The best-fitting model for ghrelin (BIC 5 4705.69) showed a signif- Figure 1b). (Kojima et al, 2005;Monteleone et al, 2005;Rigamonti et al, 2014) or no significant alteration in postprandial PYY response compared to healthy controls (Devlin et al, 2012), suggesting that exaggerated PYY response distinguishes PD from BNp. This is the first study to identify a specific biological dysregulation in PD.…”

Plasma Peptide Concentrations and Peptide-Reactive Immunoglobulins in Patients with Eating Disorders at Inclusion in the French EDILS Cohort (Eating Disorders Inventory and Longitudinal Survey)

“…In particular, in the present study, we evaluated the circulating levels of gut peptides in a single time-point. As demonstrated in medical literature [61][62][63], the altered secretion in eating disorders should be investigated dynamically with more time-points. Nevertheless, as specified in our protocol, the sampling conditions were strictly standardized: The patient's blood sample was drawn at 08.00-11.00 a.m. after an overnight fast.…”

Emerging Treatments in Eating Disorders

“…Some studies have found a blunted increase in PYY levels after test meals in patients with BN [78][79][80], while no difference in PYY levels were observed in female patients with BED [81]. Furthermore, there was a negative correlation between postprandial PYY levels and binge frequency in women [80], although it is again unclear if altered PYY levels contribute to the development of disordered eating behaviors or are a consequence of it. While several clinical trials are investigating the use of intranasal PYY in the treatment of obesity, no trials are currently registered to examine PYY agonists in the treatment of EDs.…”