Binders & Detox Guide

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DISCLAIMER: The information shared here has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure, or prevent any illness or disease. This information is intended for educational purposes only and should not be interpreted as medical advice or treatment recommendations.

Initiating Binder Therapy for CIRS in a Clean Environment

Once you know that you are in a clean environment, CIRS doctors will typically have you start binders to begin removing biotoxins from your body.

Sometimes doctors will have patients begin binders even while they are in a toxic environment, however this seems to not be the norm and often seems to cause patients more problems than if they first ensure a clean environment.

Removing biotoxins with binders is particularly important for patients who have a genetic predisposition to biotoxin illness, as their bodies lack the ability to properly recognize and remove the toxins.

Some doctors believe that binders are necessary to remove the circulating inflammatory cytokines that contribute to the CIRS symptoms.

Commonly Used Binders in CIRS Treatment

In CIRS, the most commonly used binders are bile acid sequestrant binders, such as Cholestyramine (CSM) and Welchol. These types of binders attach to bile acids–interrupting the enterohepatic recirculation pathway in which biotoxins are excreted via the liver>gallbladder>intestines but then reabsorbed in the intestinal tract.

These binders “catch” the bile acids (and likewise the biotoxins), preventing them from being reabsorbed into the body.

Prescription Binders: Cholestyramine (CSM) and Welchol

CSM and Welchol are both prescription medications. CSM can be acquired through a standard pharmacy in a preparation that typically contains sugar and/or artificial sweeteners, as well as some dyes and fillers.

Many people seem to tolerate the standard prescription CSM ok, however sensitive patients and those who prefer pure CSM without any additives can get this through a compounding pharmacy. Note that insurance often does not cover prescriptions from compounding pharmacies.

Binder Forms and Tolerability

CSM comes in a powder, whereas Welchol comes in tablets. Some CIRS doctors exclusively use Welchol due to the convenience and easy dosing of the tablets. It should also be noted that the texture of CSM can make it difficult to swallow for some patients. Welchol is apparently about ¼ the strength of CSM, due to having less binding sites.

Natural Binders: Okra Extract

There is also a natural option for a bile acid sequestrant binder: Okra extract provides the same binding mechanism as CSM and Welchol, although it is weaker yet than Welchol. For patients who cannot obtain prescription binders, Okra can be a great choice, as it is one of (if not the only) natural binders that can effectively treat CIRS, at least under the Shoemaker methodology.

A commonly used binder product that uses Okra is Mycobind by Metabolic Code.

Evaluating Other Binders for CIRS

Patients are often confused about whether other binders like charcoal, bentonite clay, zeolite, humic acid, and apple pectin will help improve their CIRS symptoms. The answer to this is not straightforward, however there seems to be more evidence pointing to bile acid sequestrant binders being effective for treating CIRS than these other binders.

Indeed, charcoal, bentonite clay, zeolite and others are effective at removing certain toxins from the body such as endotoxins and heavy metals, and are often used in conjunction with or following bile acid sequestrant binders.

An example of one of these binders would be GI Detox by Biocidin Botanicals.

Understanding the Intensification Reaction When Starting Binders

It is very important to be aware of the “intensification reaction” that can occur when starting binders, which can be a flareup of any or all CIRS symptoms, or even new symptoms.

Although this is often confused as a Herxheimer reaction, this is not the case, as the “herx” reaction is caused by toxins being released into the body from bacteria or viruses being killed. An example of a herx reaction could be experiencing flu-like symptoms after taking oregano oil to treat candida.

CIRS binders are not killing anything–but rather they are simply removing existing toxins from the body. Why exactly this causes the intensification reaction is a matter of debate among CIRS specialists, but it seems to be rooted in the fact that toxins are being moved through the body, causing an inflammatory response.

Beginning Binder Therapy

It’s critical to start binders very slowly until you know how you will react. Many doctors also recommend beginning an anti-inflammatory protocol before starting binders.

Usually this includes a “high dose” fish oil supplement or SPMs (e.g. SPM Active by Metagenics; basically these are a more “powerful” version of fish oil that contain a higher concentration of the metabolites within fish oil that have the anti-inflammatory effect).

Some patients find that curcumin, boswellia, and glutathione supplements, like S-Acetyl Glutathione, help reduce their inflammation and reactivity, and improve their tolerance to the binders and detoxification.

Dosage Tips for Starting With Binders

Since CSM is a powder, it’s relatively easy to taper up at a very low dose. Likewise with Okra-based products like Mycobind. Welchol tablets can be broken in half, but sometimes this is still too much for patients to tolerate at first.

In this case, you can make “Welchol water” where you dissolve one Welchol tablet into 6 ounces of water. Using this method you can, for example, start with just drinking 1 ounce, giving you ⅙ the strength of one tablet, and then slowly increase over time from there. Make sure to refrigerate the mixture.

Optimal Binder Dosage and Scheduling

The starting dosage for CSM and Welchol varies by patient, but the typical “full dose” of CSM is one scoop of powder four times daily with water. For Welchol it’s either 2 tablets three times per day, or 3 tablets twice per day.

Typically the binder is taken 15-30 minutes before meals, as the fat from the meal helps trigger the gallbladder to release bile (which the body uses to digest fats) and this allows the binder to be in place in the small intestine for when the bile is released.

The binder is also typically taken one hour before or after supplements or meds, as it can impact absorption of these. Doctors will often monitor the patient’s vitamins A, D, E, K as well as their lipids, as CSM, Welchol, and Okra can bind to these.

Duration of Binder Therapy in CIRS Treatment

Patients often wonder how longer they will need to be on binders for. This seems to be highly dependent on a number of factors, including the level of toxins in the patient’s environment, how well the patient’s detox pathways are functioning, the amount of toxins in the patient’s body, and how sensitive the patient is to detoxification (i.e. how much binders they can take without having an intensification reaction).

Monitoring Progress and Adjusting Binder Use

Most patients report having to take binders for 2 to 6 months before being able to move to the next step of the Shoemaker Protocol (which is usually VIP treatment), however some patients who are very resilient and can take full-dose CSM may reach this point in one month; others, particularly sensitive patients, may need a year or more.

It should be noted, however, that patients typically seem to steadily feel better as they continue the binder as long as their environment remains clean and they are not reexposed.

Progress with the binders is usually gauged using the VCS (Visual Contrast Sensitivity) Test, the patient’s lab markers, and the patient’s self-reported symptoms.

Continuing Binder Therapy as a Preventative Measure

A low dose of the binder is sometimes taken beyond CIRS treatment as a safeguard against any incidental environmental exposures. Some patients will take a low dose every day, while others will just take the binder for a short period of time following the incidental exposure.