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Cholestyramine is an ion-exchange resin that binds bile acids, biotoxins (mycotoxins, bacterial toxins), and fat-soluble compounds in the intestine, preventing reabsorption and facilitating excretion in stool. Dr. Ritchie Shoemaker's CIRS protocol uses cholestyramine as a primary biotoxin binder to interrupt the enterohepatic recirculation of biotoxins.
Commercial cholestyramine packets contain significant amounts of aspartame, maltodextrin, and other additives that patients with MCAS or chemical sensitivities cannot tolerate. Compounding pharmacies prepare pure cholestyramine powder, custom flavoring, lower doses, and capsule forms.
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Cholestyramine is a cornerstone of the Shoemaker Protocol for CIRS and mold illness. The additive-free compounded version is essential for MCAS patients and those with multiple chemical sensitivities. For bile acid malabsorption—a common cause of chronic diarrhea after gallbladder removal or Crohn's—it provides direct symptom relief.
CIRS (chronic inflammatory response syndrome) biotoxin binding, mold illness protocols, bile acid malabsorption diarrhea, hypercholesterolemia, MCAS with GI involvement, pruritus from cholestasis.
CIRS/biotoxin protocol: 4g (1 scoop) 4 times daily before meals and at bedtime. Bile acid diarrhea: 4g 1–3 times daily before meals. Cholesterol: 4–24g daily in divided doses.
Constipation (most common), bloating, gas, nausea. Impairs absorption of fat-soluble vitamins (A, D, E, K) and many medications—take all other medications at least 1 hour before or 4–6 hours after cholestyramine.
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