Bile acid sequestrants, mold, toxins and Lyme

My patient after 5 years of antibiotic treatment had been in a fairly remitted state. And then she was exposed to toxic mold and the entire Lyme syndrome became activated.  She experienced recurrent fatigue, pains, cognitive dysfunction, mood swings with emotional ups and downs, along with night sweats and other symptoms had taken multiple naturopathic therapies for detoxification which had not helped much.  We started Welchol, which had been helpful in the past and which was very effective right away. A urine test sent to Realtime laboratories showed the presence of mycotoxins. The concept is that even though the home mold issue had been remediated, mold persisted in her sinuses elaborating toxins. The treatment for this was intranasal antifungal therapy, intraconazole, combined with BEG, to treat bacteria and also break down biofilms. Topically EDTA works here to degrade biofilms mucopolysaccharide strands held together by calcium which is in turn chelated by this agent. Other aspects of her illness, including:   neuro-Lyme, Babesia and Bartonella were also addressed independently.  The addition of glutathione and methy b12 and methylfolate may promote detoxification and seem to be helpful.

Bile acid sequestrants, (BAS) primarily cholestyramine and Welchol have become popularized for their putative role in the removal of toxins. In the past, I implied, or stated that these agents remove neurotoxins. This statement cannot be supported. I do not believe they remove quinolinic acid.

QUIN, quinolinic acid is the major neurotoxin associated with Lyme neuroborreliosis and possibly many other neuro-inflammatory diseases: HIV dementia, Parkinson’s disease, motor neuron diseases, Huntinington’s disease, MS and psychiatric disorders.  It is produced and released by infiltrating macrophages and activated by glial cells. The concentration of QUIN in cerebrospinal fluid may correlate with the severity of these illnesses. QUIN serum concentration was recently shown to be associated with increased hepatic encephalopathy seen in patients with cirrhosis of the liver.  QUIN, an NMDA agonist, acts as a neurotoxin, gliotoxin,, proinflammatory mediator, prooxidant molecule and may alter the integrity of the BBB.

Many exogenous toxins have negative effects on the brain and central nervous system.

BAS have been shown to help removal of toxins from mold and some bacteria. There is no narrative to support the contention that Lyme is a biotoxin disease or that BAS removes these unsubstantiated toxins. 

BASs remove stuff. 

Bile acids are produced by the liver and circulated through the small bowel to assist in the digestion of fat, emulsification. BAS remove these substances – and other things. For example, thyroid hormone. Recent studies point to the usefulness of these agents for thyrotoxicosis. BAS also remove toxins associated with C. diff colitis. BAS have other effects which are not well understood. Their primary purpose is to lower cholesterol. Bile acids are derived from cholesterol; when they are taken away -  the liver makes new bile acids from circulating serum cholesterol therefore lowering serum cholesterol levels.  For reasons not understood, BAS also lower blood sugar. The BAS, as previously stated, has been shown to lower CRP levels, an indicator of lowered inflammation by way of complement activation. 

BAS may cause decreased adsorption of some drugs, (not most). Penicillin and tetracycline are on the list. There is a concern about fat soluble vitamins, not proved. 

Activated charcoal is also reported to remove mycotoxins. Charcoal is known as the universal antidote for poisoning; I am afraid it also indiscreetly removes drugs you want to keep on board.

As more adverse information about statin drugs comes out:  raise blood sugar, cause cognitive difficulties, cause muscle inflammation and liver inflammation --  in general, I would argue that BAS should be considered in lieu of the more toxic agents. Pharmaceutical representatives quickly point out that “data” only supports the use of statins to prevent cardiovascular disease. Older studies with cholestyramine showed similar results: new studies will never be done with these drugs because of economics. But I digress.