Treatment Strategies to Support Patients with Low Gut Motility

Many functional integrative medicine practitioners would agree that a fundamental principal of their practice is to pinpoint the root cause of dysfunction in order to truly help patients. Yet, this is not always easy to do, and some patients can be more frustrating than others. Such is true for patients with small intestinal bacterial overgrowth (SIBO), especially if numerous approaches to remove unwanted bacteria in the small intestine provide unsuccessful results.

SIBO is a common condition, where there is an overabundance of bacteria in the small intestine that is difficult to get rid of. But what is causing this overgrowth of bacteria in the first place? Impaired motility has been linked to SIBO and should be addressed as a root cause.¹

How Motility Affects GI Health

Motility in the GI tract describes the movement of food and other substances from the stomach and small intestine into the large intestine and out of the body. Between meals, the migrating motor complex (MMC) is a specific three-phase cycle of motility that facilitates transport and “sweeps” indigestible substances and bacteria continually forward through the GI tract, inhibiting stasis or backward migration. In phase 3 of the MMC, brief and intense propagating contractions are responsible for most of the “sweeping” activity. Dysfunction or absence of phase 3 is associated with SIBO.¹

There are several factors that can inhibit MMC activity, including stress, sluggish thyroid function, irregular eating patterns, and bacteria and immune imbalances in the gut. In fact, autoimmunity following infection by a pathogen producing cytolethal distending toxin B may be the leading cause of MMC impairment.²

Treatment Approaches

In addition to eradication of SIBO,¹ serotonin is shown to induce phase 3 of the MMC. So, serotonin (5-HT4) receptor agonists (e.g., metoclopramide, clebopride, mosapride) are commonly prescribed as prokinetics to reboot motility.

Recent studies are demonstrating that herbal-based motility agents work in a similar fashion. This is good news for the functional integrative medicine practitioner that wants a natural prokinetic approach for their patients. 

Ginger and artichoke have a unique synergy to stimulate motility and relieve GI symptoms associated with SIBO.³ Motility can be stimulated by the molecular actions of ginger root’s lipophilic extracts, which modulate the integrated network of cholinergic M3 and serotonergic 5-HT3/5-HT4 receptors.^3,4,5

With the complementary anti-spasmodic and choleretic actions of artichoke extract, full motility can be naturally restored^3,5 to ensure steady movement of food particles and bacteria through the stomach and small intestine and into the colon, precisely what SIBO patients need.

The Bottom Line

The research behind prokinetic treatment approaches is advancing, giving the functional medicine practitioner a broader array of treatment strategies to assist in treating root cases of SIBO. Herbal-based prokinetics in the form of ginger and artichoke have efficacy as a prokinetic and may offer functional medicine practitioners a natural alternative to prescribed serotonin receptor agonists.

Joseph Ornelas, PhD, DC holds a PhD from University of Illinois with concentration in Health Economics, an MA degree in Public Policy from the Harris School at the University of Chicago, an MS degree in Health Systems Management from Rush University, and a DC degree from National University of Health Sciences. As a licensed provider and health economist, Dr. Ornelas has published numerous evidence-based clinical practice guidelines, helping to improve quality standards of care and provide value for health care practitioners across several specialty areas.

References