Why a Prokinetic?

by | Aug 27, 2019 | Nutrition | 4 comments


Each year that I have been in practice, the more clients I see with small intestinal bacteria overgrowth (SIBO). When I opened my business over 3 years ago, SIBO was not a term in my vocabulary. I honestly don’t remember where and when I first heard about it. Now I have individuals reach out to me not only to help with diet, but if multiple rounds of Rifaximin didn’t help, what can they do? I have learned much about SIBO and how to help those struggling with it. This is a growing issue, where it is estimated that 60% of those with IBS actually have SIBO.

If this is the first time you are hearing this SIBO term, here is a short explanation. Our small intestines have some bacteria, but most of the bacteria resides in the large intestine/colon. With SIBO, there is more bacteria than normal in the small intestine. This makes it difficult to maintain a healthy gut environment. What happens? This bacteria in the small intestine begins fermenting the food being consumed causing multiple gut issues, including bloating, distention, gas, diarrhea, constipation, etc. Unlike irritable bowel syndrome (IBS), SIBO often needs further intervention above and beyond diet changes, either in the form of a prescription ordered by your physician or herbal supplements.

One aspect of SIBO that most clinicians agree on is the importance of maintaining that migrating motor complex (MMC). This cleansing wave is natural for everyone to have and occurs during a fasting state. Those with GI issues tend to have a more sluggish digestive tract, so it is important to help that MMC do its job more easily.

Two main ways to keep the MMC moving is to space meals 4-5 hours apart (no small frequent meals) and taking a prokinetic. The definition of a prokinetic is stimulating movement or motility, such as a drug that promotes gastrointestinal motility. The bottom line is that a prokinetic helps keep things moving throughout the GI tract. For those with SIBO this is important. Intestinal dysmotility plays a crucial role in the severity of symptoms and motility issues itself can be a cause of SIBO. Keeping that MMC going allows the bacteria to migrate towards the large intestine, effectively stopping accumulation of bacteria in the small intestine.

If you have SIBO and you are not on a prokinetic agent there are options. Your physician can prescribe a prokinetic drug, such as low-dose Erythromycin or Resolor® (Prucalopride). There are other options for prescription prokinetic drugs, but these are the two I see often. If you would rather not take a prescription, there are herbal prokinetic agents that many find to be helpful. Iberogast® and Motility Activator® are two of the herbal choices along with a handful of others.

If you have SIBO and have been through treatment, now is a good time to start a prokinetic agent. If you want a prescription, reach out and discuss it with your physician. If you lean towards herbals and you need help figuring out which type and dose, reach out to a dietitian or functional practitioner that specializes in treating SIBO.

The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek the advice of your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.


Meet Valerie

Registered Dietitian Nutritionist - CDN, RDN

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.

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