SIBO and prokinetics
The missing piece In Treating Methane Dominant SIBO- (IBS-C and IBS-M)
Hey Everybody Dr Hagmeyer here. If you have been diagnosed with Small intestinal bacterial overgrowth (SIBO) then the frustrations of dealing with bloating, and gas, constipation or diarrhea is probably getting pretty old.
Today I wanted to give you some insight into a very important key area that you should be aware of that might be one of the missing pieces in your quest to overcome SIBO- and that piece is something known as a prokinetic.
So what is a prokinetic, what do they do, why are they important?
Prokinetics are drugs or herbal compounds that cause strong contractions and emptying of either the stomach contents or the small intestine.
What they do is stimulate the migrating motor complex (MMC), which are the cleansing waves that are activated between meals and during fasting. I like to think of them as the intestinal sweepers. They sweep debris and bacteria along the GI tract.
Intestinal motility can get off track for a number of reasons, sometimes the immune system attacks the nerve cells which control motility- this is autoimmune IBS or autoimmune SIBO where a person has antibodies against vinculin.
For other reasons, perhaps the MMC contractions are not strong enough, or they don’t occur at the right time or they don’t last as long. Whatever the reason, this is where prokinetics provide the greatest help in resetting the MMC.
Here is the connection to SIBO?
People who have IBS-C or IBS-M or people who have had a positive Methane Breath Test usually have problems with the MMC-
If your body is unable to move food, waste and bacteria down and out, and on top of it there is an issue with the ileocecal valve, then bacteria, parasites and co-infections can easily overgrow into the small bowel.
Any time the MMC slow down or becomes dysregulated, you are slowing down the sweeping, cleansing actions which are so integral to GI health and immune health.
So one thing you may want to start doing to lighten the load on the MMC is eating smaller LOW FODMAP meals and spacing them out.
So what else can you do to help out the MMC?
Supplement with Prokinetics! Earlier we talked about what a prokinetics is, why they are important and how they can help-
One thing I want you keep in mind that there are many kinds of prokinetics and I usually recommend patients start with the natural ones first before resorting to drug based prokinetics.
Unfortunately, I see too many doctors jumping in and using the drug based prokinetics as a first line of defense.
Couple other things that are worth mentioning when it comes to prokintics.
#1- Take your prokinetics at night before bed and depending on the person and the severity of methane, take them between meals.
#2 Rotate them as I find this helps with their effectiveness.
Some of the prokinetics that I think work the best in my experience are things like
5HTP- 5HTP is a precursor to serotonin and we know that serotonin has a direct impact on the nerves that affect gastric motility. Too little serotonin and we have constipation, too much serotonin and we have diarrhea.
One word of caution when it comes to 5HTP- Unfortunately many people who have IBS suffer with depression or anxiety, are already taking antidepressants- so you need to be careful with supplementing with something that has the ability to increase serotonin levels. It can be done- but I suggest you do under the guidance of your doctor.
Another natural prokinetic you should be aware of is Ginger. You can drink ginger tea but I also suggest you take it as a supplement. Making Ginger tea is super easy.
Take a chunk of ginger- use a carrot slicer or just cut it into thin slices. Fill up a pot of water and boil it for 10 minutes and that how simple it.
Another prokinetic is Triphala -Triphala is an Indian herb made up of three fruits. What I like about, Triphala it that not only is a very powerful prokinetic, it also has antibacterial, antiviral, antioxidant, antitumor and adaptogenic properties.
In one study, When researchers compared the Triphala herb Harada (Terminalia chebula) to prokinetic drugs they found that Terminalia chebula increased gastric emptying by 86 percent, compared to 76 percent for metoclopramide.
Since Terminalia is free of side effects, the herb may be a useful alternative to the prokinetic drugs currently available.
One of my favorite minerals when it comes to motility issues, is Magnesium – Approximately 300 bodily enzymes require magnesium, which suggests that magnesium is vital for most cells and tissues of the body.
From a neurological standpoint, Magnesium is very important in helping balance the sympathetic and parasympathic nerve system. You may remember we talked about the Vagus nerve and its role in motility and other GI problems. Magnesium is essential in maintaining normal vagal tone.
There are so many different kinds of prokinetics that it is impossible for me to go over all of my favorites- but one question I am often asked about when it comes to prokinetics is,
“Can I or (should I) take a prokinetic if I have diarrhea or a test that shows elevated hydrogen levels on a breath test.
This is a great question!
If you have been diagnosed with SIBO, keep in mind that you’re SIBO due to an overabundance of bacteria living in the small intestine, not an excessive amount of gastrointestinal motility in the small intestine. Once you fix the overgrowth issue, the motility issue will also be corrected.
I want to leave you with 5 final thoughts from today’s video
#1- If you seem to be making slow progress with your GI issues it may be time to be thinking about Prokinetics and the MMC
#2 If your MMC is unable to move food along and move waste out appropriately, bacteria can easily overgrow.
#3-Take your prokinetics before bed, rotate them and take them between meals if necessary
#4- a slow Migrating motor complex is usually due to methane while a rapid MMC is associated with Hydrogen.
#5- I also suggest you watch the video I did on manual manipulation of the ileocecal valve this video will show you the who, what, where when and why of this important valve.
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Until next time, take care
Links to some of my favorite Prokinetics