Abstract
Cholestyramine is an effective drug for the reduction of plasma cholesterol because of its ability to sequester intestinal bile acids. Since metabolic alterations, including diminished intestinal absorption of vitamin D and osteomalacia have been reported with long-term use of this resin, the influence of cholestyramine on dietary balance of four mineral elements has been investigated. Wistar-strain rats were fed either a 2% cholestyramine or control diet for one month. Dietary intakes and fecal and urinary excretions of calcium, magnesium, iron, and zinc were determined using atomic absorption spectrophotometry during three, 3-day balance periods. Cholestyramine-fed rats had a net negative balance for calcium and a lower net positive balance for magnesium, iron, and zinc than the controls. Other effects of cholestyramine were an increased urinary excretion of calcium and magnesium, a decreased urinary zinc, and an alkalinization of urine. Blood and tissue cation content was unchanged except for a rèduction in serum magnesium with resin feeding. Alterations in calcium, magnesium, and zinc metabolism might be explained by inadequate vitamin D absorption from the intestine followed by an increased secretion of parathyroid hormone. A diminished iron absorption due to resin binding could account for the reported disturbance in iron balance.
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Hunninghake DC, Probstfield JL: Drug treatment of hyperlipoproteinemia in hyperlipidemia:In Hyperlipidemia: Diagnosis and Therapy. BM Rifkind, RI Levy (eds). New York, Grune and Stratton, 1977, pp 337–362
Heaton KW, Lever JV, Barnard RE: Osteomalacia associated with cholestyramine therapy for post-ileectomy diarrhea. Gastroenterology 62:642–646, 1972
Whiteside CH, Harkins RW, Fluckiger HB, Sarett HP: Utilization of fat soluble vitamins by rats and chicks fed cholestyramine, a bile acid sequestrant. Am J Clin Nutr 16:309–314, 1966
Thompson WG, Thompson GR: Effect of cholestyramine on the absorption of vitamin D3 and calcium. Gut 10:717–722, 1969
Hashim SA, Van Itallie TB: Cholestyramine resin therapy for hypercholesterimia. JAMA 192:289–293, 1965
Runeberg L, Miettinen TA, Nikkila EA: Effect of cholestyramine on mineral excretion in man. Acta Medi Scand 192:71–76, 1972
Coronato A, Glass GBJ: Depression of the intestinal uptake of radio-vitamin B12 by cholestyramine. Proc Soc Exp Biol Med 142:1341–1344, 1973
Thomas FB, McMullogh FS, Greenberger NJ: Inhibition of the intestinal absorption of inorganic and hemoglobin iron by cholestyramine. J Lab Clin Med 78:70–80, 1971
Cassidy MM, Lightfoot FG, Grau L, Roy T, Story J, Kritchevsky D, Vahouny G: Effect of bile salt-binding resins on the morphology of rat jejunum and colon: A scanning electron microscopy study. Dig Dis Sci 25:504–512, 1980
Cassidy MM, Lightfoot FG, Vahouny GV: Morphological aspects of dietary fibers in the intestine. Adv Lipid Res 19:203–229, 1982
Asano T, Pollard M, Madsen D: Effects of cholestyramine on 1,2-dimethylhydrazine-induced enteric carcinoma in germfree rats. Proc Soc Exp Biol Med 150:780–785, 1975
Vahouny GV, Roy T, Gallo L, Story JA, Kritchevsky D, Cassidy MM, Grund B, Treadwell C: Dietary fiber and lymphatic absorption and cholesterol in the rat. Am J Clin Nutr 31:S208–210, 1978
Analytical Methods Committee: Methods for the destruction of organic matter. Analyst 85:643–654, 1960
Van Loon JC: Analytical Atomic Absorption Spectroscopy: Selected Methods. Academic Press, New York, 1980, p. 189
Watkins DW, Cassidy MM, Khalafi R, Vahouny GV: Calcium and zinc balances in rats chronically fed the bile-salt sequestrant cholestyramine (Questran). Fed Proc 42:819, 1983 (abstract)
Goodman LS, Gilman A: The Pharmacological Basis of Therapeutics, 6th ed. Macmillan, New York, 843 pp
Hanna S: Influence of large doses of vitamin D on magnesium metabolism in rats. Metabolism 10:735–743, 1961
Becker WM, Hoekstra WG: Effect of vitamin D on65Zn absorption, distribution and turnover in rats. J Nutr 90:301–309, 1966
Antoniou LD, Shalhoub RJ, Elliot S: Zinc tolerance tests in chronic uremia. Clin Nephrol 16:181–187, 1981
Watkins DW, Antoniou LD, Shalhoub RJ: Urinary zinc in relation to other cations and flow during volume expansions and intervenious chlorothiazide. Can J Physiol Pharmacol 59:562–566, 1981
Lemann J Jr, Litzow JR, Lennon EJ: Studies of the mechanism by which chronic metabolic acidosis augments urinary calcium excretion in man. J Clin Invest 46:1318–1328, 1967
Muldowney FP, Freaney R, McGeeney D: Renal tubular acidosis and aminoaciduria in osteomalacia of dietary or intestinal origin. Q J Med 37:517–539, 1968
Nordin BEC: The effect of intravenous parathyroid extract on urinary pH, bicarbonate and electrolyte excretion. Clin Sci 19:311–319, 1960
Sutton RAL: Plasma magnesium concentration in primary hyperparathyroidism. Br Med J 1:529–533, 1970
Sutton RAL: Disorders of renal calcium excretion. Kidney Int 23:665–673, 1983
Dirks JH: The kidney and magnesium regulation. Kidney Int 23:771–777, 1983
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Supported by USDA grants 82CRCR 1071 and 82CRCR 1001.
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Watkins, D.W., Khalafi, R., Cassidy, M.M. et al. Alterations in calcium, magnesium, iron, and zinc metabolism by dietary cholestyramine. Digest Dis Sci 30, 477–482 (1985). https://doi.org/10.1007/BF01318182
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DOI: https://doi.org/10.1007/BF01318182