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Molly Maloof, MD

Director of Clinical Content

OTC Option for Welchol

I have been on Welchol for five years due to a bile acid disorder. I don't have a family doctor at the moment, and I am almost out of them. I'm kind of looking to keep costs down right now, so was hoping there was an OTC equivalent. Prior to starting this, I would have diarrhea 30+ times a day, bile would be thrown up and excreted and any food or drink would as well, still in the state I ingested it in. I really can't afford to see a doctor now for the refill since I've relocated.
  • Female | 43 years old
  • Complaint duration: 90 days
  • Ethnicity: Caucasian / White
  • Height: 63
  • Weight: 135lbs
  • Medications: Welchol
  • Conditions: Bile Acid Disorder

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Featured Answer

4 UpVoted this answer
Hello -- bile acid induced diarrhea is not uncommon following gall bladder removal. Some times, the content of one's diet is a major variable - because without one's gall bladder, bile secretion into the intestine following a meal is lacking - and fatty foods will proceed through the intestine without adequate mixing with bile - and bile acids are essential for fat absorption. The bile acid "binders" are charged molecules that bind to bile acids in the intestine, inhibiting bile acid laxative effect AND inhibiting cholesterol absorption too. Their essential action is to inhibit the lower intestinal reabsorption of bile acids (which is typically over 95%). Bile acid passage into the colon will cause irritation and even inflammation there - which contributes to diarrhea and colon discomfort. Three bile acid sequestrants are available in the United States: cholestyramine (Questran), colesevelam (Welchol) and colestipol (Colestid). These are equivalent though cholestyramine is oldest and thus least expensive. Exact non prescription options of these resins are not manufactured -- HOWEVER, other natural products can and do bind bile acids and thus reduce bile acid diarrhea and bile acid colitis. These are psyllium, flax fiber, chia seed fiber, and less powerful - apple and grapefruit pectins. Saponins are also available and work well -- marketed as Immun-Stat --- and pro biotics also help. Of all of these, I recommend the following: High Fiber Oat Meal for daily breakfast - two packets per day if instant - aim for 10 grams per packet - thus 20 grams per breakfast or other meal. Plus: psyllium powder daily - follow directions - space out in PM; Plus Flax Seed Powder - can add to oatmeal; Plus one apple per day; Plus Eliminate Trans Fats, Eliminate Saturated Fats, Minimize Chocolate; Start a Pro Biotic of any brand per day. Best wishes.
Dr. Mahnensmith, thank you from the bottom of my heart. This is the first workable plan I have been presented with, and it's a game changer. I bought everything this weekend, and still spent far less than an office visit and prescription. Just in two days, I do notice a difference. Thank you for listening, and for seeing me through a way to function without being terrified I won't reach a bathroom in time. God bless.
It's bile acid absorption. It got worse after I had my gallbladder out several years ago. I've Googled until my fingers bled. There are all kinds of products that state they can help, but I don't want to spend a fortune I don't have on something that may not work, or make it worse. I don't know the first thing about finding a medical school clinic, this is a pretty rual area. I had to stop seeing my rhumetologist and GI because they are over an hour away and I ran out of vacation time to go see them. And regarding my diet, if I drink water in the morning, water comes out - both ends, with bile. If I eat crackers, beans, soup, any type of meat, vegetable ... bile. I don't know. This was a shot in the dark and I give up. Thanks anyway.
Bile is essential to digestion, and the body has a very efficient method to manage bile acids. It is not clear to me what you are trying to treat. If a cholesterol problem there are OTC methods to reduce. If a bowel or digestive issue, there are different methods. Various fresh produce can bind bile acids. I would suggest that if you have a significant medical issue, you can enroll in a medical school clinic and get good care. I would also suggest that you google bile acids and the disorder you are trying to treat. As an integral part of the digestive process, bile can be positively effected by foods, therefore not medication. It is always better in these chronic conditions to rely on natural therapy by adjusting your diet
There is no substitute OTC for Welchol.

I recommend you to visit your local health department office, they can't assist you if you can't afford to see a doctor.
Andreas Grossgold