The debate between the benefits of natural vs. synthetic treatments sometimes plays out without considering scientific evidence. For most patients, a treatment that is natural or that involves a change in diet is more desirable than taking a synthetic medication. However, medications that are synthesized in labs provide help to millions of people every day. To the healthcare providers that prescribe these medications, the benefits outweigh the risks. Cholestyramine is a resin sold under the brand name Questran that is available in pure form from a compounding pharmacy. Various alternatives to taking cholestyramine have been proposed but none are as effective.
History and Current Use of Cholestyramine
Cholestyramine has been used to treat high cholesterol since the 1970s. Decades later, healthcare providers started using it to treat mold-related biotoxin illness. Cholestyramine binds to bile acids that contain toxins. It forms a complex and both the cholestyramine and the toxins are removed naturally from the body. The cholestyramine is not absorbed into the blood stream – it binds to toxins in the gut then is completely expelled.
Chronic inflammatory response syndrome (CIRS) related to mold exposure can be difficult to treat. The Shoemaker protocol for treatment of mold-related illness is one of the more well-known protocols. It calls for the use of cholestyramine to remove toxins from the body along with the use of BEG nasal spray. For most patients, cholestyramine works well. It has few negative side effects when used as directed. However patients have sometimes sought to get the same effects from plant-based alternatives or changes to their diets.
Are There Alternatives to Cholestyramine?
Patients have sought alternatives to cholestyramine for a variety of reasons. One reason may be budgetary constraints. While this medication used to be covered by most insurances, there are now far fewer companies that will reimburse for it. The cost for a one-month supply is not as much as many other drugs but it may still be higher than some patients are willing to pay. Another reason patients seek alternatives is to find a treatment that is more “natural” and not synthesized. For these patients there are numerous plant and mineral options available, some that have been used therapeutically for thousands of years.
Binding to Bile Acids: Vegetables vs. Cholestyramine
Many vegetables and plant materials have properties that aid in removing toxins from the body. Bile acids are usually re-absorbed in a process called enterohepatic circulation. Cholestyramine helps treat high cholesterol and biotoxin illnesses by interrupting this re-absorption and allowing bile acids to be removed through fecal matter. Vegetables can produce a similar effect, just at a lower level. Some vegetables that are effective at binding to bile acids include okra, beets, and asparagus.
It is well-known that vegetables have numerous health benefits and should be a major part of any diet. When it comes to binding toxins in the gut however they are not as effective as cholestyramine. Here is a list of vegetables that have mild to moderate potential as binders. The percentage is their relative effectiveness at binding bile acids compared to cholestyramine. Beets are the most effective while cauliflower is the least effective in this sample.
- Cholestyramine – 100%
- Beets – 54%
- Okra – 34%
- Asparagus – 13%
- Eggplant – 4%
- Turnips – 3%
- Green Beans – 3%
- Carrots – 3%
- Cauliflower – 2%
Clay and Charcoal
Bentonite clay and activated charcoal are also sometimes used by patients seeking to remove toxins from their body. Bentonite has been used both externally and internally for thousands of years by many different cultures. It may be used on the skin to treat irritation from poison ivy and poison oak. When taken orally it can absorb various toxins in the gastrointestinal system. However there is not sufficient evidence to show that it is more effective than cholestyramine for removing toxins.
Activated charcoal derived from plant sources like coconut shells is also used to remove toxins from the gastrointestinal system. Numerous health benefits have been associated with consuming activated charcoal however there are varying amounts of evidence for some claims. Activated charcoal does bind to cholesterol and bile acids in the intestine to prevent their re-absorption. In studies there have been positive results using activated charcoal to manage accidental ingestion of medicines and overdose.
Pure Cholestyramine Resin
One of the complaints some patients have with commercial medications is that they have numerous additives. These “inactive ingredients” may actually produce side effects in certain individuals who are sensitive to them. A compounding pharmacy can provide pure cholestyramine resin, which has no fillers or sweeteners. For patients who are prescribed a bile acid sequestrant for their mold-related illness, a pure form of cholestyramine may be the best option. Keeping a healthy diet with lots of vegetables and fruits is an excellent way to improve overall health and recover from illnesses. However, a prescription-strength bile acid sequestrant like cholestyramine is usually necessary to achieve a complete recovery.
Research
- In vitro binding of bile acids by okra, beets, asparagus, eggplant, turnips, green beans, carrots, and cauliflower – Food Chemistry
- Effect of activated charcoal on apixaban pharmacokinetics in healthy subjects – American Journal of Cardiovascular Drugs
“However there is not sufficient evidence to show that it is more effective than cholestyramine for removing toxins.” Is there sufficient evidence to show that bentonite is AS effective (or even 80%) of cholestyramine for removing toxins?
We have not found evidence of this. In general studies show bentonite is significantly less effective than cholestyramine as a binder.
Is there any information about the efficacy of zeolites being used for this..??
Yes, some naturopathic doctors will use zeolite as a binder. It still will not have as significant of a binding effect as cholestyramine.
Do you know the Activated Charcoal percentage of relative effectiveness at binding bile acids compared to cholestyramine?
We do not have the research on this comparison at this time.
My Doctor would like me to use more charcoal and less Cholestyramine. I know how much cholestyramine works for me. The charcoal is far less potent. It would be helpful to know how these compare. Has anyone made the switch before?
We do not have any information on how that switch should be made, and would suggest talking with your doctor. Charcoal is a supplement and not something that we dispense as a medication.
Thank you SO much for this article and for answering all of my questions! 🙂
ANY STUDIES ON THE EFFECTIVENESS OF BENTONITE CLAY IN ABSORBING BILE ACIDS?
Bentonite clay has been used as a remedy for numerous conditions and has been used to bind toxins. However we do not have the studies on this product.
Hi, is there any issue with taking my cholestyramine at the same time as Zeolite? I’ve read mixed things. The main argument against taking them at the same time is that CSM is positively charged and Zeolite is negatively charged so it is less effective when taken at the same time. That said, I’ve also heard that Zeolite has a positive charge when mixed with water. Thank you.
We are not aware of any medical use of zeolite and do not suggest it be used in conjunction with cholestyramine. Some doctors do use zeolite as a binder but it is not something we sell at our compounding pharmacy. Always talk with your doctor before changing your medical regimen.
If using cholestyramine to remove mold toxins, should cholestyramine be taken on an empty stomach? If so, how long of no food before or after using cholestyramine, or does it matter?
Usually prescribers recommend taking on empty stomach and waiting 30 minutes to eat and if you eat, wait about 60 minutes before taking.
Does Cholestyramine bind to medications and pull them out too though? How would that work with medications that you need to stay in your system 24/7? Does it bind to nutrients and other supplements?
Cholestyramine can interact with any medications you are taking. You should consult with your doctor to see if any medication you are taking prohibits you from using cholestyramine.
I take 10 mg of Crestor. Can I also take Cholesytramine at the same time to heal my mold illness?
For medical advice we would suggest first speaking with your doctor or calling the pharmacy to speak with a pharmacist.
The vegetables as bile binders is interesting. Is there similar information on other foods as bile binders? For example how does oatmeal compare to beets as a bile binder?
You may be interested in this article which compares oatmeal to cholestyramine: https://pubmed.ncbi.nlm.nih.gov/16248587/