How Cholestyramine is Used

This page contains educational material about Cholestyramine Use in biotoxin illness. This information is for educational purposes only. Nothing in this text is intended to serve as medical advice. All medical decisions should be made only with the guidance of your own personal medical authority. I am doing my best to get this data up quickly and correctly. If you find errors in this data, please let me know.

The cholestyramine pages on this site:

Cholestyramine: What is It

Cholestyramine: Why is it used in CIRS & How It Works

Cholestyramine: How to Take It/Safety

Cholestyramine: Alternatives - Research on Biotoxin Binders

Dr. Tilgner's Book: Herbal Medicine From the Heart of the Earth is Available Here!bookphoto

Protocol Outline for taking cholestyramine for biotoxin illness

•  Take on an empty stomach. Take 4 grams of pure cholestyramine or 9 grams of Questran, or as prescribed.

•  Mix with 6 oz of water or apple juice and drink. Follow with another 6 oz of water or more.

•  Wait 30-60 minutes and then eat your meal. To decrease binding of important nutrients in meals, wait the full 60 minutes.

•  Take Medications 30 minutes before cholestyramine or 2 hours after.

•  If you forget the cholestyramine and eat, wait for 1 hour before taking the next dose of cholestyramine.

•  Take 4 doses of cholestyramine per day

•  If you have indigestion, reflux, or constipation see information below.


Deatils of How to Take Cholestyramine, Safety, Detoxification Reactions, Contraindications & Adverse Reactions

How is Cholestyramine used?
To bind biotoxins, 4 grams of Cholestyramine is taken 4 times per day. (Dosing for children or people under 120# needs to be altered accordingly.) Cholestyrmine products on the market usually mix Cholestyramine with other ingredients to make it taste better and mix into water better or look more appealing to the user. These products are often in 9 gram doses (4 grams of cholestyramine and 5 grams of additives.) However, some folks with biotoxin illness are unable to take Cholestyramine with these additives and their practitioner has a compounding pharmacist provide Cholestyramine without these extra ingredients since a pure cholestyramine is unavailable on the open market.
It is taken 30 minutes prior to a meal. Make sure the meal has at least 1 teaspoon oil/fat in it. Could be one egg or a pat of butter/coconut oil etc. This will get the bile going at the correct time to meet up with the Cholestyramine. Take it 30 minutes before breakfast, lunch and dinner and then at bed. Drink a minimum of 12 oz of water with it, but better to drink more if you are able. This helps decrease constipation from the Cholestyramine. For people who are concerned about constipation or having a reaction from pulling out the biotoxins, start slow at 1 gram (1/4 dose) 2 times per day on day one. If no problems increase to 2 grams (1/2 dose) the next day for two times that day, then 3 grams or ¾ dose day 3 for two doses that day and the full dose on day 4 but still only two times. Then on day 5 go to using the full dose of 4 grams Cholestyramine 3 times per day, 30 minutes before meals and on the 6th day 4 times, with the last dose before bed. Four doses each day is best, but for some people due to drug regimens or other reasons they can only take it three times per day.  

If you eat first, wait at least 1 hour before taking your next dose of Cholestyramine.

When Can I take other medications:
Take all medications one hour prior to taking the Cholestyramine or two hours after taking cholestyramine. Do not take any food with them unless necessary for the medicine and then only what is necessary and try to stay away from eating fatty foods if possible.

How Long is it used?
It is usually used until a person’s Visual Contrast Sensitivity test normalizes. (Link to test here. It is generally prescribed for one month. This allows the body to completely dump all the biotoxins out of the body via the bile. Usually, people report feeling better the first week. However, generally they need to use it for the full month to get the full effect. Additionally, if the person is re-exposed to biotoxins again (see list of biotoxins) they will once again need to remove these biotoxins with a bile sequestrant such as Cholestyramine.

Is it Safe?
It has been used for more than forty years and many patients have taken it for  long periods of time. The FDA ruled in 1999 that there was no reason to expect an increased risk from giving Cholestyramine to patients with biotoxin illnesses, such as mold, pot-Lyme, cuguatera, pfiesteria and blue green algae syndromes compared to those who do not have biotoxin illnesses.

Detox Reactions (Also see Contraindications & Adverse Reactions)
Some people report a detox reaction. If the person has a significantly high MMP-9 level this is more likely to happen and can be lessened or negated by using Omega-3-fatty acids and the no-amylose diet for ten days. On day 6 the patient starts the Cholestyramine.

Dr. Ritchie Shoemaker (CIRS due to water-damaged buildings pioneer and leader in field) has noted that reactions to cholestyramine treatment may be specific to CIRS causes and are often associated with various illnesses or lab makers. For instance the person with a significantly elevated MMP-9, a history of ciguatera, Lymes or MARCoNs  may have a worsening of symptoms with taking Cholestyramine. True intensification or worsening of clinical presentation, will result in a fall in VCS scores in row E by day 3 (after Cholestyramine treatment begins) followed by a fall in row D. MMP-9  will rise from baseline. (If this happens Lymes should be ruled out as well as MARCoNs.)

What is thought to be happening when detox reactions occur?
This usually happens around dose 6-10. It is more common in Post Lyme patients than others. It is thought that the reaction is tied to a dissociation constant of toxins to receptors. If the binding is tight, like ciguatera the intensification never occurs. If the toxins are internalized into dendritic cells such as in mold and cyanobacteria toxins, there is no intensification.
When the Cholestyramine binds the toxins and they are removed with it in the stool, this pushes the dissociation to the right to release more toxin from everywhere in the body. Before the newly released toxins go into the bile and are removed by the Cholestyramine they cause an intense release of cytokines in the body. This in turn causes the inflammation that leads to the various detox symptoms.

How long until I feel better?
Generally people notice improvement the first week. Most people feel much better after a month. Treatment is faster for the young and slower for the elderly. The sicker can take longer to get well. Other reasons it may take longer are poor compliance with Cholestyramine, the person may still be exposed to toxins (Did they remove themselves from all water-damaged buildings or remediate their home appropriately?) They also may have a MARCoNs infection.

Digestion reactions that may happen
Common reactions early on in treatment are reflux of stomach acid (heart burn), bloating, belching and general indigestion, constipation. Some people will dissolve the Cholestyramine in apple juice to help reduce the heartburn. This really does help. Some people also find  dissolving it in luke-warm water and then adding ice will help reduce heartburn.

What can be done about the constipation?
The simplest thing is that patients are helped by drinking more water. 16 oz with each dose is best. 12 oz is necessary at minimum. Drinking more water thru the day is also necessary. Fruits such as plums and cherries are helpful. Some people use water soluble fiber such as psyllium seed. Research has shown psyllium mixed with cholestyramine works better to lower cholesterol than cholestyramine by itself. It may be that it will work similar with biotoxins although there is not research on it. If using the water soluble fiber,  drink plenty of water with it. Some patients find using vitamin C to bowel tolerance can be helpful, while others use magnesium for constipation.  Those using Vitamin C, usually take it 1 hour prior to taking their Cholestyramine dose or they take it with their meals. Most patients are taking 1 -2 grams 4 times per day. They back off the dose if they get loose bowels. Magnesium is taken with meals usually in 100 mg doses per meal. While magnesium glycinate is a good form to absorb, magnesium citrate is a better form if you want to induce bowel evacuation. The vitamin C and magnesium is only used as a solution to constipation if water, fruit and water soluble fiber is not helping enough.
5- Hydroxytryptophan (5-HTP), a supplement that people take at night to help them sleep, also helps move the intestines to promote evacuation of bowel contents. People sometimes take this at night before bed to help them sleep and have a bowl movement in the AM. Vitamin C, magnesium and 5-HTP should not be substituted for drinking lots of water.

Some patients with chronic biotoxin illness have diarrhea or softer, frequent stools. For these people the cholestyramine is usually beneficial as it helps to solidify their stool.

Contraindications & Adverse Reactions for Cholestyramine?
Research has shown that Choleystyramine is not absorbed, but entirely removed in the feces. Problems that arise therefore are usually related to its action in the gut.
It is not given to kids under 3 years old.
It is not indicated for oral consumption if there is complete biliary obstruction where bile is not secreted into the intestine. It is also not indicated in individuals who have shown hypersensitivity to it or any of it’s components.
Choleystramine binds bile acids, so it may therefore interfere with normal fat digestion and absorption and thus may prevent absorption of fat-soluble vitamins such as A,D,E and K. When Cholestyramine is given for long periods of time, concomitant supplementation with water-miscible or parenteral(shots) forms of fat-soluble vitamins should be considered.
The adverse reactions are largely due to Cholestyramine binding bile acids and causing fat soluble vitamin deficiencies or binding of drugs. Cholestyramine also lowers cholesterol. Many people find this to be a plus, however some may have low cholesterol and this could be a problem. The most common adverse reaction is constipation.
Please go to this link for an extensive list of less common adverse reactions:

Where do people get Cholestyramine?
A prescription is necessary in the United States.
If you want pure Cholestyramine without additives you need to get it from a compounding pharmacist.
In the United States we have a couple products that are common on the market. The following list of ingredients in them is from this link:

QUESTRAN® (Cholestyramine for Oral Suspension, USP), the chloride salt of a basic anion exchange resin, a cholesterol lowering agent, is intended for oral administration. Cholestyramine resin is quite hydrophilic, but insoluble in water. The cholestyramine resin in QUESTRAN is not absorbed from the digestive tract. Four grams of anhydrous cholestyramine resin is contained in 9 grams of QUESTRAN POWDER. QUESTRAN POWDER contains the following inactive ingredients: acacia, citric acid, D&C Yellow No. 10, FD&C Yellow No. 6, flavor (natural and artificial), polysorbate 80, propylene glycol alginate, and sucrose (421 mg/g powder).

Four grams of anhydrous cholestyramine resin is contained in 6.4 grams of QUESTRAN LIGHT. QUESTRAN LIGHT (Orange Vanilla) contains the following inactive ingredients: aspartame, citric acid USP anhydrous, D&C Yellow No. 10, FD&C Yellow No. 6, flavors (natural and artificial Orange, natural and artificial Vanilla Cream), maltodextrin, magnesium sulfate USP heptahydrate, propylene glycol alginate, colloidal silicon dioxide, and xanthan gum.   

If you do not want these additives in your Cholestyramine, you will need to have your practitioner order it from a compounding pharmacist.                                                                                      
Please note that Questran Light contains aspartame which should never be consumed by people with the genetic condition knows as phenylketonuria or PKU.
Additionally, there are other people who react to aspartame too.

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