If you’re living with primary biliary cholangitis (PBC), you may already know that cholestyramine is often prescribed to help manage itching, one of the most common symptoms. While this medication can bring relief, it also comes with some dietary do’s and don’ts.

Certain foods can interfere with how well cholestyramine works or raise your risk of side effects. Knowing which foods to avoid can help you feel better, get the most benefit from your treatment, and protect your liver health.

This article covers seven types of food and drink to steer clear of when taking cholestyramine for PBC, along with tips to support your well-being. Be sure to talk with your doctor or a registered dietitian before making changes to your diet or medications.

What Is Cholestyramine?

Cholestyramine is a prescription drug that’s often used to lower cholesterol levels. However, for people with PBC, it’s also used to relieve itching. That’s because cholestyramine removes bile acids from the body. In PBC, bile acids can build up and cause itching, so getting rid of them can help you feel better and support your quality of life.

Cholestyramine can interact with other medications, so your healthcare provider will help decide if it’s right for you based on your health history and needs. Your doctor will tell you how much to take and how often, as well as provide any other instructions you need to use cholestyramine effectively.

Timing Cholestyramine Around Food and Vitamins

Cholestyramine can affect how your body absorbs certain nutrients— specifically, vitamins A, D, E, and K. Many people with PBC take some of these fat-soluble vitamins as supplements or get them through foods like leafy greens, dairy, and meat.

To help your body absorb these vitamins properly, be mindful of when you take cholestyramine. Try to take your vitamins or eat foods rich in these nutrients either one hour before or four to six hours after your dose. It’s important to follow your doctor’s or dietitian’s recommendations about supplements because fat-soluble vitamins may be harmful in high doses. When possible, aim to get these nutrients from food instead of pills.

Foods To Avoid When Taking Cholestyramine

Some foods can make cholestyramine less effective, especially those high in fat. Others may worsen common side effects like nausea, constipation, bloating, or vomiting.

To help cholestyramine work as intended and to feel your best, you’ll want to follow a PBC-friendly diet. Health experts usually recommend a Mediterranean diet, full of fruits and vegetables, unsaturated fats, lean meats, and complex carbohydrates.

With that in mind, here are seven types of foods to try to avoid while taking cholestyramine for itching caused by PBC.

1. Fried Foods

Fried foods are high in fat, which can make cholestyramine less effective and harder on your digestive system. Some common examples include:

• French fries and onion rings
• Chicken fingers and fried chicken
• Doughnuts
• Tempura
• Mozzarella sticks

When dining out, look for healthier options. For instance, ask for a salad or steamed vegetables instead of fries. Skip fried appetizers, and choose grilled or baked options when possible. At home, use lighter cooking methods like baking, sauteing, or air-frying.

2. Full-Fat Dairy

Full-fat dairy products can increase digestive side effects like constipation and bloating, especially when taken with cholestyramine. Obvious sources include milk, yogurt, cheese, butter, ice cream, and sour cream. However, dairy may also show up in:

• Mixed drinks (both alcoholic and nonalcoholic)
• Sherbet
• Creamy salad dressings

Opting for nonfat or low-fat versions may help. If you’re not sure whether a food contains dairy, check the label or ask about the ingredients.

3. Sweetened Foods

Foods with added sugar or artificial sweeteners don’t directly interact with cholestyramine, but they can worsen cholestyramine side effects like nausea and bloating. You may already know to watch out for candy, cookies, and cakes. However, sugar also shows up as a flavor booster in many other foods, such as:

• Juices, sweetened coffee drinks, and soda
• Sauces and condiments like barbecue sauce and ketchup
• Sweetened or fat-free yogurt
• Breakfast cereals and granola
• Nut butters and protein bars
• Processed or packaged foods

The best way to avoid added sweeteners is to read nutrition labels or look up nutritional information. Look for ingredients such as corn syrup, fruit juice concentrate, or anything ending in “-ose” (like glucose or sucrose) — all these are forms of sugar.

4. Processed Meats

Many processed meats are high in fat and should be avoided or limited when taking cholestyramine. Examples include:

• Sausage and bacon
• Ham and salami
• Chicken nuggets
• Hot dogs
• Jerky
• Most deli meats

If you eat meat, choose fresh, lean options like skinless chicken, turkey, or fish instead. Talk to your doctor or dietitian about the best protein choices for your diet.

5. Pizza

Pizza combines several foods best avoided with cholestyramine, including high-fat cheese and processed meats like pepperoni and sausage. If you crave pizza, consider making it at home. Choose a whole-grain crust, sprinkle it with low-fat cheese, and pile on chopped veggies instead of processed toppings. Homemade versions give you more control and may be easier on your digestive system.

6. Spicy Foods

Spicy foods don’t interact with cholestyramine, but they can make stomach issues worse — especially if you already have nausea, heartburn, or vomiting from the medication.

Everyone reacts differently to spicy foods. If you regularly eat spicy dishes and don’t have problems, you may be able to eat them while on cholestyramine, too. Start with small amounts and see how your body responds. If your symptoms get worse, it may be best to skip spicy foods while using cholestyramine.

7. Alcohol

Alcohol doesn’t directly affect how cholestyramine works, but healthcare providers usually recommend avoiding alcohol or drinking very moderate amounts when living with a liver disease like PBC. Ask your healthcare provider whether alcohol is safe for you — and if so, how much. They can help you weigh the risks and make the best decision for your health.

Speak With Your Doctor About Your Diet

If itching from PBC is affecting your quality of life, ask your healthcare provider whether cholestyramine could help. They can help explain how it works, whether it’s a good fit for you, and how to take it safely and effectively.

If you’re already taking cholestyramine, ask about any food or supplement questions you have. They’ll help you understand what to eat — and what to avoid — to feel your best. They can also refer you to a dietitian if you want more help figuring out what to eat to support both your treatment and your health.

Talk With Others Who Understand

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, members come together to ask questions, give advice, and share their tips with others who understand life with PBC.

Do you take cholestyramine for PBC? What foods have you avoided because of your medication? Share your experiences in the comments below, or start a conversation by posting on your Activities page.