If you’ve been diagnosed with Small Intestinal Bacterial Overgrowth otherwise known as SIBO, then without a doubt this is a pretty big frustration. It’s probably getting pretty old dealing with bloating and gas, abdominal pain, constipation and diarrhea on a regular basis. In this article, I want 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 overcoming GERD (gastroesophageal reflux disease), methane dominant SIBO or IBS constipation. This piece of the puzzle is known as prokinetic agents.
What is a Prokinetic
So what is a prokinetic, what do they do?, why are they important? Are prokinetic agents necessary when you have SIBO? Watch the video below.
Prokinetic Medications and How They Helps Your Gastrointestinal Tract?
Prokinetic agents are drugs or herbal compounds that cause strong contractions and emptying of either the stomach contents or the intestinal contents. Prokinetic agents work by activating the 5-ht4 receptors for your serotonin hormone which results in increased GI tract emptying. Some prokinetic agents also are responsible for the increased acetylcholine release. Increased acetylcholine release also produce enhanced gastrointestinal peristalsis that increases pressure on your lower esophageal sphincter and accelerates gastric emptying.
What prokinetic agents essentially do is they stimulate the migrating motor complex which are the cleansing waves in our gastrointestinal tract that basically are activated between meals or during fasting states. This migrating motor complex functions as the intestinal sweepers of our body. They are sweeping debris, bacteria and other contents along the GI tract.
Gastrointestinal tract motility disorders can be due for a number of reasons, sometimes our immune system attacks certain nerve cells which control motility and this is what we call autoimmune IBS. This type of IBS is becoming more common through the testing and the research that’s been done looking at antibodies against a very special protein called vinculum.
Motility can also get off to a bad start because the migrating motor complex is not contracting as strong as it should be, it’s not contracting as frequently as it should be, they don’t occur at the right time or they don’t last as long. There’s a lot of different potential scenarios that can be occurring, but whatever the reason people that suffer with constipation, GERD or methane dominant SIBO will find that the addition of a prokinetic agent can be one of the greatest things in resetting their migrating motor complex (MMC).
What Else Can You Do To Support The Migrating Motor Complex or MMC?
Another thing you can do if you have problems your migrating boarder complex is supplementing with prokinetics. There’s many different kinds of prokinetics and I usually recommend that patients start out with of course the more natural ones first then resort to the the drug-based prokinetic like erythromycin. I wrote about 7 ways to improve the MMC here
Unfortunately, what happens is I see too many doctors that jump all in and using the drug-based prokinetics as a first line of defense when there are many things that naturally work. If only more doctors , took the the time to really investigate a patient’s case, successful outcomes would be the norm.
Side Effects of Erthromycin – Drug based Prokinetics
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 as they should. Whatever the reason, this is where prokinetics provide the greatest help in resetting the MMC.
The most used drug-based prokinetic agents to treat GI motility disorders are metoclopramide and erythromycin. But these two drug-based prokinetics are not without adverse effects.
Erythromycin has been related to cardiac toxicity, tachyphylaxis or sudden decrease in response to a drug, cardiac arrhythmia and bacterial resistance. While metoclopramide is known to have adverse effects such as tardive dyskinesia or loss of control of facial movements, akathisia or restlessness, and cardiovascular side effects but this reactions are rare.
Prokinetics And The Connection to SIBO?
A classic example of how prokinetic agents can be very beneficial is when a patient who suffer from gastrointestinal disorders such as GERD (gastroesophageal reflux disease) and IBS (constipation dominant irritable bowel syndrome or IBS M) see again that the result of their SIBO breath test is positive for methane.
If your body is unable to move food, waste and bacteria down and out, essentially what we’re gonna end up with is a problem with the ileocecal valve. The bacteria and the parasite coinfection will develop and it will result in a bacterial overgrowth process. Keep in mind that your MMC is very important in this development. Anytime we slow down the migrating motor complex or it becomes dysregulated, you are essentially slowing down that sweeping cleansing action which again is such an integral part of gastrointestinal health and also immune system health.
In order to resolve this GI tract issue, you may want to start to lighten up the load so to speak on the MMC. This can be done by following a low fodmap diet and eating smaller meals and then spacing those smaller meals further out throughout the day. so if you’re person who eats throughout the day and you’re kind of a grazer, you eat while you work but you nibble all day long that’s not a good thing when you have SIBO.
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 Support The Migrating Motor Complex or MMC?
Another thing you can do if you have problems your migrating boarder complex is supplementing with prokinetics. There’s many different kinds of prokinetics and I usually recommend that patients start out with of course the more natural ones first then resort to the the drug-based prokinetic like erythromycin.
Unfortunately what happens is I see too many doctors that jump all in and using the drug-based prokinetics as a first line of defense when there are many things that naturally, if we take the time to really investigate a patient’s case that can be very advantageous to that patient.
Tips For Taking Prokinetic Agents
There are two things that are worth mentioning when it comes to prokinetics. Number one is you want to take your prokinetic agents at night before bed. Depending on the person and the severity of methane, you can take them all throughout the day. But the key here is take them between meals or right before bed. Number two is that I often suggest that you rotate the kind of prokinetics that you’re using. Base on my experiences with my patients, what I’ve noticed is it just tends to be more effective that way.
4 Natural Prokinetic Supplements for SIBO
As mentioned earlier, drug-based prokinetic agents can have adverse reactions or bad drug interactions to other drugs that you are taking. So here are my favorite natural prokinetic supplements you can take to help you with your GI motility disorders.
Prokinetic #1: 5-HTP
5-htp is a precursor to serotonin. Serotonin has a direct impact on the enteric nerves that affect gastro intestinal motility. Too little serotonin and we have things like constipation but on the flip side of that when we have too much serotonin we often have diarrhea.
It is important to understand when it comes to 5-htp is that many people who suffer with irritable bowel syndrome also suffer with things like anxiety and depression. If you suffer from anxiety or depression maybe you’re already taking a drug like an SSRI. This is one scenario where I really suggest that you exercise caution to avoid adverse effects or be sure to be working with a doctor who understands that and is not afraid to kind of walk you through that process because it can be quite scary if things go off in the wrong direction.
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 so under the guidance of your functional medicine doctor.
Prokinetic #2: Ginger for Prokinetic
Another natural prokinetic you should be aware of is Ginger. I recommend that you drink 2-3 cups ginger tea, but I also suggest you take it in supplement form. The problem with most store bought ginger and ginger tea is that it can be difficult to get enough of the active ingredients that are need to bring about therapeutic change. Gingerols ( 6-gingerol, 6-shogaol, and 6-paradol) are the active ingredients that provide the therapeutic efficacy and prokinetic effect.
Make Your Own Ginger Tea to enhance Gastric Emptying
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’s how simple it is.
I have used many ginger supplements but this is one the one I have seen the best result with. You can order it here
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.
I have used many Ginger supplements but this is one the one I have seen the best result with. You can order it here
Prokinetic #3 Triphala
Triphala is an Indian herb made up of three fruits. What I like about, Triphala it that not only is a very powerful natural prokinetic, it also has antibacterial, antiviral, antioxidant, antitumor and adaptogenic properties. This is the Triphala I use with my patients
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 Erythromycin and other prokinetic drugs currently prescribed.
Prokinetic #4 Magnesium
Another one of my favorite natural Prokinetics is Magnesium. But not just any magnesium, Magnesium Glycinate. Magnesium Glycinate is 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. Magnesium is essential in maintaining normal vagal tone.
Prokinetic #5 Motility Pro
Struggling with a motility disorder or Methane Dominant Small Intestinal Bacterial Overgrowth? For people with IBS and SIBO slow motility is a major problem that can leads to bloating, gas and constipation. Motility PRO is a combination of ginger (Zingiber officinale) and artichoke leaf extract (Cynara cardunculus L.) delivered at a clinically proven dose to restore gastric motility. This distinctive blend of bioactives promotes contractions in the migrating motor complex, helping to restore proper motility, which ensures the steady flow of food particles and bacteria through the small intestine. In addition, it provides support for improved digestion and relief from gas, bloating and associated GI discomfort.
Methane Dominant SIBO
Methane dominant SIBO, also known as methane SIBO or constipation SIBO, is a form of small intestinal bacterial overgrowth. The predominant microbe, called Methanobrevibacter smithii, is an archaeon which can convert hydrogen into methane, resulting in slowed intestinal transit. This kind of Methane dominant SIBO
Prokinetic and Constipation
Due to the accelerated gastric emptying and increased bowel movement effect of prokinetics, prokinetics are popularly used in treating gastrointestinal motility disorders such as chronic constipation and other common symptoms of irritable bowel syndrome and SIBO.
Should You Take Prokinetics If You Have Diarrhea?
There are so many different kinds of natural prokinetics, that it is impossible for me to go over all of my favorites- but one question I am often asked when it comes to prokinetics is… If prokinetics accelerate gastric emptying and increase bowel movements, won’t prokinetics make my diarrhea worse? 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 many causes of an overgrowth issue, motility disorders will also be corrected. So in most cases- prokinetics are still very much needed.
Remember prokinetics (or prokinetic agents) are substances that increase gastrointestinal motility/emptying. In almost all cases, prokinetic agents should be used as part of SIBO treatment for people with IBS-D,IBS-C and IBS-M. From the research we have done and implemented at DrHagmeyer.com we believe that Natural Herbs work just as effectively if not better in most cases. Keep in mind, that SIBO is more than just killing and overgrowth and that the Root cause must be addressed!
Natural prokinetic agents also have a long history of use throughout the world and are much safer than many of the prokinetic agents widely prescribed in conventional medicine.
Best Time To take Prokinetics
Pro-kinetic medications are often dosed in the evening for SIBO prevention, and do not (necessarily) impact large intestine motility, which is why we still recommended them for patients with diarrhea-type SIBO.
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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