As discussed in prior articles, Cholestyramine (CSM) and Colesevelam (Welchol) are the only binders that have data to support their use in CIRS patients. These are the only binders that are part of the Shoemaker Protocol for CIRS. They are quaternary anions meaning they are positively charged. Charcoal, Chitosan, Zeolite and others are the wrong chemical charge and have no data to support their use. Others like Okra Pepsin are the right charge, but are very weak binders.
When taken orally, CSM and Welchol bind negatively charged Biotoxins in the Duodenum that are being secreted by the Liver in bile. This is how they interrupt enterohepatic circulation in those with HLA genetic susceptibility to Biotoxin Illness (CIRS). Otherwise, the toxins recirculate indefinitely due to defective antigen presentation and failure of the innate immune system to mount an effective response to remove them. Once bound, the toxins then come out in the stool. So, it is important to have a stool daily or the toxins will eventually be released from the binders and be reabsorbed.
In order for the binders to work effectively, there must be adequate biliary secretion of toxins. For many years, we have been recommending CSM and Welchol to be taken on an empty stomach 30 or more minutes prior to a meal or 2 hours after a meal. New data is suggesting this is not the best timing.
It is best to take binders 1 hour after a fatty meal to increase bile and toxin secretion . Fat will stimulate bile secretion to digest them. Bile also stimulates stool movement through the colon. While there will be some binding to the food and cholesterol, the benefits of taking binders with a fatty meal far outweigh that. You need to eat more fat and protein with much less carbohydrates. For those doing the carnivore diet and intermittent fasting, you are not having breakfast, This is definitely healthier for our bodies, but does make taking the binders three or four times daily a challenge. Therefore, it is important to have a fatty snack mid afternoon and perhaps prior to bedtime. This can include some fatty lunch meat, hard cheese, avocado, smoked salmon, or a shot of olive oil, avocado oil, or coconut oil. Take the binder shortly after the snack.
There are also supplements available to improve Liver function and bile secretion (Cholagogues). Lipotropic Complex from Integrative Therapeutics contains methionine, milk thistle, dandelion, beet root, radish, fringe tree bark, and ox bile. Bilemin from Apex Energetics contains dandelion, milk thistle, beet root, ginger and phospholipids (phosphatidylcholine), Either will be helpful. This should be taken with the meal, prior to binders. Start with 1 at each meal and if you have significant Liver issues or no Gall Bladder, take 2 at each meal. I will be recommending this to most of my patients as they are inexpensive and we need to optimize every part of this detox process. They especially help with constipation from the binders. If you are getting loose stools, you will need to cut back. CSM and Welchol bind bile acids needed to keep your bowels moving.
Having a stool daily can be a challenge, especially for those following the meat based, carnivore lifestyle. Following this protocol does result in less constipation from the binders. Drink a lot of water, have fruit if possible (prunes and kiwi work well, but have a lot of sugar), plant fiber, and aloe vera juice. Senna can be taken every few days, but not daily. Magnesium oxide or citrate powder can be taken as needed to soften and stimulate stools.