Medicine boasts its fair share of long words. Cholestyramine is one of those long words which we use a lot at Sanctuary Functional Medicine when we’re caring for our patients who suffer from biotoxin illness such as mold. Typing or saying it over and over gets tiring, so we use the acronym CSM in the office and will do so here. We use it a lot not just because mold toxicity experts like Dr. Ritchie Shoemaker have emphasized it for years, but for two other reasons as well. One, I have seen it work in helping patients to recover. Two, there is research supporting it.
To some degree, if you have not experienced CSM’s benefits or watched mold toxic patients benefit from it, you will have to take my word on the former. On the other hand, there is research you and I can review together which helps you appreciate its effects. For some, this may help you decide to implement this therapy in recovering from mold toxicity. (Do so only under medical guidance). For others, this will help you defend your use of the therapy to another medical provider or a skeptical family member.
Many don’t believe that mold can cause such weird and disabling and chronic symptoms. Both patients and their medical providers are constantly having to prove ourselves that this is real. So as we have already been doing, we will continue to provide some “proof” for you and others to convince others around you. Today we offer this article in support of both the reality of mold toxicity AND the benefits of detoxification therapies like CSM.
The article begins with an overview of a mold toxin called ochratoxin A which is known from multiple studies to cause kidney and immune dysfunction along with cancer. Most of that research has been on food contaminated with the toxin, but also some on inhalational exposures from water damaged buildings. It is included as one of 20 mold toxins monitored in the food supply by government authorities.
It continues with an overview of how Ochratoxin A is processed in animals. In ruminants like cattle, gut bacteria and digestion break down the toxin and prevent accumulation in the body. In other animals, the toxin can accumulate and cause damage through binding to DNA, through oxidative stress, and other mechanisms. It seems to persist in humans due to its binding to proteins which prevent our detoxifying it. The binding likely contributes to the fact that it has been found in a multitude of different tissues including kidneys, liver, adrenals, skin, heart, bone marrow, muscle, liver, and more.
Next, the article mentions a few substances which can increase or decrease the effects of Ochratoxin A on the body. Melatonin, vitamin A, vitamin E, Vitamin C, and licorice root all have studies showing protective effects if given prior to toxin exposure. The amino acid phenylalanine and oddly the artificial sweetener aspartame also show protective effects.
A short section addresses whether the amount of Ochratoxin A found in human food is sufficient to cause human toxicity. Short answer… It does not clearly contribute but is likely a minor contributor compared to inhalation which is addressed in a longer section.
Ochratoxin A and its effects on kidneys, reproduction, immunity, and brain are then reviewed.
Finally, we come to the effects of cholestyramine on Ochratoxin A. Cholestyramine is a bile acid binding resin. Bile acids are produced by the liver and excreted into the GI tract to help absorb dietary fats. The liver attempts to excrete Ochratoxin A into the bile- and thus into the GI Tract- in order to rid the body of the toxin. If nothing else intervenes, though, the bile, along with dietary fats and the Ochratoxin A, is reabsorbed into the blood stream. The toxin just keeps recirculating in the body without leaving.
When taken orally, CSM is not absorbed into the blood stream but remains in the GI tract after ingestion. CSM was originally used as a cholesterol binding agent to lower cholesterol for cardiovascular health. CSM binds not only cholesterol and dietary fats, but also binds the Ochratoxin A (which is fat soluble). When the toxin is bound to the CSM and the CSM is not reabsorbed, it passes out in the stool and exits the body.
If this were only theoretical, we would ask for proof. Studies support this mechanistic theory. In a referenced study, rats fed CSM and exposed to the Ochratoxin A had lower levels of the toxin in their blood and urine but higher levels exiting in their stool.
The article then reviews other mechanisms of harm by Ochratoxin A and other means of possible detoxification such as charcoal, sweating, and other supplements. While not a full compendium of research supporting CSM’s use in Ochratoxin A toxicity, this offers a great introduction to the mold toxin and support for using CSM in removing it to treat illness. As a functional MD, I enjoy sharing this research with my patients so that you can understand what you are facing and are able to explain it to others, whether they are supportive or skeptical. Truth equips us to fight against disabling conditions like mold toxicity.
Reviewed article:
Hope, J. H. and B. E. Hope (2012). “A Review of the Diagnosis and Treatment of Ochratoxin A Inhalational Exposure Associated with Human Illness and Kidney Disease including Focal Segmental Glomerulosclerosis.” Journal of Environmental and Public Health 2012: 835059.
Additional referenced study of rats and CSM therapy:
- Kerkadi, C. Barriault, B. Tuchweber et al., “Dietary cholestyramine reduces ochratoxin A-induced nephrotoxicity in the rat by decreasing plasma levels and enhancing fecal excretion of the toxin,” Journal of Toxicology and Environmental Health A, vol. 53, no. 3, pp. 231–250, 1998.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
