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