Cholestyramine - Questran
Questran, or Cholestyramine, is a bile binding medicine. It is approved by the FDA for the treatment of high cholesterol.

I am prescribing it for an off label use (something other than lowering cholesterol).  If you have had Lyme or an exposure to toxic mold, your body has been processing  biotoxins.  Normal people process these toxins through the immune system and through the liver.  Some people, identifiable through their HLA type, have immune systems lacking the capacity to inactivate biotoxins.   This means that the liver is doing the majority of the work involved in processing toxins.  These people have far more serious illness with Lyme or with mold exposure.   After being treated for Lyme they will not return to feeling well until the toxins are removed. 
A test that can indicate toxin exposure is the VCS test.   It is most useful to take the test before starting the Questran and every 4 weeks.  You will stop Questran after 4 weeks of when the test normalizes, whichever comes first. 

As I have prescribed it, the purpose of cholystyramine is to bind the small biotoxins that are being processed by your liver so that they are not reabsorbed into your body during digestion.   If you have the genetic susceptibility to chronic inflammatory illness, you have always been inefficient in clearing biotoxins.  Therefore you likely have toxins throughout your body.  As the cholystyramine binds the toxins and allows the backlog of toxins to be excreted in the bile, other tissues in the body release stored  toxins.  Your immune system is very likely to react. 

Cholystyramine  does not absorb into the body, but rather has its effect solely the in the digestive system.  Therefore, any side effects you have from the medicine are either in the digestive system or are caused by something else.  In people with chronic inflammatory problems, the “something else” is usually the immune system reacting to toxins.

I follow Dr Shoemaker’s suggestion that my patients should pretreat before using cholystyramine.  He uses.  Actos and a low amylose diet.  Many insurance companies do not pay for Actos, which is expensive.  Fish oil is the next best alternative.   TO use fish oil take 2 grams of high quality fish oil 3 times a day, sticking to a low amylose diet.  Low amylose diets contain no wheat or wheat-like grains, no sugar, no bananas, and no root vegetables (potatoes or sweet potatoes).    You only need to be on this for 10 days to block the strong immune system reaction to the toxins.  HOWEVER, many people find they feel better if they continue the low amylose diet and fish oil.

Problems with Questran can be allergic reactions, side effects of the medicine (in which case they are limited to the digestive system), or they are consequences of the mobilization of toxins. 

Allergic Reaction:  hives; difficulty breathing; swelling of your face, lips, tongue, or throat.  Stop the medicine immediately and go to the Emergency Room  
Stop the medicine immediately and go to the Emergency Room  if you have any bleeding from the mouth or rectum. 

For digestive side effects:  bloating nausea constipation abdominal discomfort:  You may need to move more slowly on the dose.  Some people cannot tolerate Questran at the doses he prescribes.  However, I must defer to Dr Shoemaker on the dosing.  He indicated that to be effective it needs to be taken 1 scoop  4 times daily. 

Feeling Worse:  If taking Questran makes you feel as if all of your typical symptoms are WORSE, Dr Shoemaker’s model would suggest that this is an immune system reaction to the toxins being released.  His data indicate that this effect will last several days and will be worse in people who have had Lyme disease.  It WILL pass eventually.  There is no requirement that you continue to take a medicine that makes you feel ill.  However, if the Questran is working as Dr Shoemaker believes, it gradually lead to a correction of your visual contrast sensitivity test (VCS ) and an improvement in your overall symptom picture.  I have found this to be true for many patients. 

DOSE:  The dose Dr Shoemaker recommends is one scoop four times a day.  You may lower the dose and increase to the full dose more slowly if you have problems.  However, you will need to be on the fish oil and low amylose diet until you have taken Questran at full dose for 5 days.  
Questran derived from wheat, but according to the manufacturer is gluten free.  It is does contain corn products. 

Dr Shoemaker indicates that the typical exacerbation of symptoms occurs at doses 6-10.  It seems to occur when the toxins are released from receptors.  
Here is a link to more information on CHolystyramine

People often express concern about the amount of sugar in Questran.  It is extremely cheap when taken in the form provided by the drug company.  The raw ingredient is only sold at exorbitant cost.  My local compounding pharmacy found it to cost about $800 for a month’s worth.  You can sometimes get raw cholystyramine through Hopkinton pharmacy – this will require a different prescription.  You may call them and discuss the price

Home Dr. Cathryn Harbor, M.D.