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Questran
Depletes
Prolonged use of Questran can impact 4 essential nutrients.
Folic Acid
Bile acid sequestrants work by binding to cholesterol and bile acids in the intestine, unfortunately, they can also bind to folic acid, hindering its uptake into the bloodstream. For individuals taking bile acid sequestrants, supplementing with folic acid may be advisable to prevent or address potential deficiencies.
Replace with 5-Methyl Folate (200 mcg)
Research: Threlkeld DS, ed. Cardiovascular Drugs, Antihyperlipidemic Agents, Bile Acid Sequestrants. In Facts and Comparisons Drug...
Vitamin A
Bile acid sequestrants work by binding to cholesterol and bile acids in the intestine, unfortunately, they can also bind to fat soluble vitamins like vitamin A, hindering its uptake into the bloodstream. For individuals taking bile acid sequestrants, supplementing with vitamin A may be advisable to prevent or address potential deficiencies.
Replace with 67% Retinol;33% Beta carotene (1,500 IU)
Research: Probstfield JL, Lin TL, Peters J, Hunninghake DB. Carotenoids and vitamin A: the effect of hypocholesterolemic agents on...
Vitamin D3
Bile acid sequestrants work by binding to cholesterol and bile acids in the intestine, unfortunately, they can also bind to fat soluble vitamins like vitamin D3, hindering its uptake into the bloodstream. For individuals taking bile acid sequestrants, supplementing with vitamin D3 may be advisable to prevent or address potential deficiencies.
Replace with Chloecalciferol (1,000 IU)
Research: Shojania AM, Grewar D. Hypoprothrombinemic hemorrhage due to cholestyramine therapy. CMAJ. 1986;134(6):609-610. M S Matsui...
Vitamin E
Bile acid sequestrants work by binding to cholesterol and bile acids in the intestine, unfortunately, they can also bind to fat soluble vitamins like vitamin E, hindering its uptake into the bloodstream. For individuals taking bile acid sequestrants, supplementing with vitamin E may be advisable to prevent or address potential deficiencies.
Replace with Vitamin E (d-alpha tocopherol with mixed tocopherols) (30 IU)
Research: Threlkeld DS, ed. Cardiovascular Drugs, Antihyperlipidemic Agents, Bile Acid Sequestrants. In Facts and Comparisons Drug...
Health Impact
Questran-induced nutrient depletion can lead to a range of health problems
High Homocysteine & Vascular Risk
Meta-analyses of randomized trials show that folic acid supplementation lowers homocysteine and modestly reduces stroke and overall cardiovascular disease risk in some populations, especially where baseline folate status is low, highlighting the adverse vascular profile of folate deficiency.
Research: Li Y et al. Folic acid supplementation and the risk of cardiovascular diseases: a meta-analysis of randomized controlled...
Folate-Related Megaloblastic Anemia
Hematology and nutrition reviews describe folate deficiency as a classic cause of megaloblastic anemia and mucosal abnormalities, frequently exacerbated by medications that antagonize folate metabolism.
Research: O’Leary F, Samman S. Vitamin B12 in health and disease. Nutrients. 2010;2(3):299-316. (discussion of folate and B12 in...
Night Blindness & Dry Eyes
WHO and ophthalmology literature identify vitamin A deficiency as a leading cause of preventable childhood blindness worldwide, with graded ocular signs (night blindness, conjunctival xerosis, Bitot spots, corneal involvement) used to monitor population deficiency.
Research: Gilbert C. The eye signs of vitamin A deficiency. Community Eye Health. 2013;26(84):66-67.; World Health Organization....
Weaker Epithelial & Gut Immunity
Public health studies demonstrate that vitamin A supplementation reduces mortality and infection-related complications in deficient children, underscoring the consequences of chronic depletion.
Research: Sommer A. Vitamin A deficiency and clinical disease: an historical overview. J Nutr. 2008;138(10):1835-1839.; WHO. Global...
Bone Demineralization & Fractures
Meta-analyses show that low 25(OH)D levels are associated with higher fracture risk, and that combined vitamin D and calcium supplementation can reduce fractures in specific high-risk groups.
Research: Yao P et al. Vitamin D and calcium for the prevention of fracture. JAMA Netw Open. 2019;2(12):e1917789.; Martineau AR et al....
Higher Infection & Illness Risk
Systematic reviews and meta-analyses report that vitamin D deficiency correlates with higher infection risk and that supplementation modestly reduces acute respiratory infection risk in many trials, especially in those with low baseline levels.
Research: Martineau AR et al. Vitamin D supplementation to prevent acute respiratory infections. BMJ. 2017;356:i6583.; Jolliffe DA et...
Neuropathy & Ataxia From Low E
Case series and reviews document that vitamin E deficiency, particularly in fat-malabsorption syndromes, can cause progressive sensory neuropathy and ataxia that may improve with high-dose replacement.
Research: Chan KH et al. Sensory axonopathy associated with vitamin E deficiency. Case Rep Neurol Med. 2021;2021:7971715.; Puri V et...
Side Effects
Common side effects of Questran, some of which may be related to nutrient depletion
Review
Common side effects of Questran (cholestyramine) may include:

1. Constipation
2. Abdominal pain or cramping
3. Nausea
4. Vomiting
5. Diarrhea
6. Gas or bloating
7. Decreased appetite
8. Skin rash or itching

Less common but more serious side effects may include:

1. Elevated triglyceride levels
2. Vitamin deficiency (especially fat-soluble vitamins A, D, E, and K)
3. Bleeding disorders
4. Liver problems
5. Gallstones
6. Muscle pain or weakness

It is important to talk to your doctor if you experience any severe or persistent side effects while taking Questran.
Get Support
We've curated a list of vetted, recommended individual nutrient third-party supplements.
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solaray
Vitamin A (Beta Carotene -25% ; Retinyl Palmitate-75%)
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Vitamin A (Beta Carotene -25% ; Retinyl Palmitate-75%)
Solaray's Vitamin A supplement provides a potent dose of this essential nutrient to support vision, immune function, and overall health.
Strength: 7500 mcg

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Vitamin A (Beta Carotene -25% ; Retinyl Palmitate-75%)
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Vitamin D3 (Cholcalciferol) (1000 IU)
by Nordic Naturals
Vitamin D3 (Cholcalciferol) (1000 IU)
Nordic Naturals Vitamin D3 supplement provides a high-quality, natural source of vitamin D3 to support bone, mood, and immune health, formulated for optimal absorption and effectiveness.
Strength: 25mcg

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Folate
by Pure Encapsulations
Folate
Pure Encapsulations' Folic Acid supplement provides a high-quality, bioavailable form of folic acid to support healthy fetal development, cardiovascular health, and overall cellular function.
Strength: 800 mcg

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lifeextension
Vitamin E (d-alpha tocopherol) 33 mg; mixed tocopherols 6.6mg (providing d-gamma, d-delta and d-beta tocopherols)
by Life Extension
Vitamin E (d-alpha tocopherol) 33 mg; mixed tocopherols 6.6mg (providing d-gamma, d-delta and d-beta tocopherols)
The Vitamin E supplement by Life Extension is designed to provide antioxidant support and promote overall health by delivering a potent blend of tocopherols and tocotrienols.
Strength: 50 IU

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Vitamin E (d-alpha tocopherol) 33 mg; mixed tocopherols 6.6mg (providing d-gamma, d-delta and d-beta tocopherols)
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