This post will help explain the function, and benefits of using a prokinetic and how it can affect SIBO.

What is a prokinetic agent

The word means promoting (pro) and move (kinetic), so it’s about promoting movement.

Prokinetic supplements and medicines help to amplify and coordinate the gastrointestinal muscular contractions to facilitate the transit of the contents of your digestive tract.

This means they are useful to encourage the movement of food through the upper part of the gut, and also the migrating motor complex (MMC).

This means prokinetic agents can do two things for helping manage your SIBO:

1. Stimulate and co-ordinate the passage of foods through the intestine, though influencing the nervous system to increase the smooth muscle contractions. 
2. May decrease transit time but they aren’t meant to cause a bowel movement like a laxative would (see below for more on that aspect).

Prokinetics can work on the upper GI tract, or the whole digestive system. These agents are particularly helpful for symptoms where motility isn’t effective and things are either moving back upwards, or stagnating.

You could be experiencing upward movement of air (frequent burping), nausea or acid reflux (where stomach acid burns the oesophagus). Prokinetics may be helpful for promoting stomach emptying and upper gastrointestinal symptoms. 

You can also use prokinetic agents for symptoms like:

• Feeling very full / Stomach not emptying quickly
• Bloating
• Gas
• Constipation

Prokinetics aren’t the same as laxatives

As I mentioned above, prokinetic agents shouldn’t be confused with laxatives. The differences are as follows:

• Laxatives should cause a bowel movement either through increasing bulk, bringing water into the gut, or stimulating the large intestine to evacuate.  
• Laxatives don’t stimulate the migrating motor complex (you can read more about the internal house keeper which keeps your gut clean – the migrating motor complex)
• Prokinetics won’t stimulate a bowel movement, and can be used with people who have IBS-D.

The way they work is by acting on neurotransmitters that control our gut motility.

Medical agents affecting motility include Domperidone (often used for sickness), Prucalopride, Naltrexone, or Erythromycin. These last two are taken at a very low dose to create the prokinetic effect.  

Herbal prokinetic supplements

Herbal prokinetic include ginger which has a long history of traditional use for nausea and sickness. Ginger is also an antioxidant anti-inflammatory agent which can support immune health which might also help in SIBO. 

You also can try taking ginger to help you consume more food if nausea and fullness is preventing you from eating a a proper sized meal. This can be helpful if you’re worried about unintentional weight loss. 

When should you take a prokinetic agent for SIBO?

Firstly, it’s important to note that prokinetics are only part of the solution for SIBO. You also need to work on diet, eating habits, and lifestyle changes such as sleep, exercise and stress management. Just popping some supplements won’t help on its own!

There are two cases when a prokinetic agent might be helpful

• As soon as you’ve finished your round of antibiotic or antimicrobial supplements to address the SIBO the prokinetic could help to stimulate the MMC. This could help slow down the SIBO relapse (and unfortunately you might well relapse after a round of treatment). Taking the prokinetic before bed is best to help the overnight fast enable the MMC process. 
• To improve symptoms such as nausea, feelings of fullness and belching. You can take the prokinetic alongside your treatment for SIBO such as the antimicrobial herbal supplements. 

When should you take a prokinetic for SIBO?

Firstly, it’s important to note that prokinetic agents are only part of the solution for SIBO. You also need to work on diet, eating habits, and lifestyle changes such as sleep, exercise and stress management. Just popping some supplements won’t help on its own!

There are two cases when a prokinetic might be helpful

• As soon as you’ve finished your round of antibiotic or antimicrobial supplements to address the SIBO the prokinetic could help to stimulate the MMC. This could help slow down the SIBO relapse (and unfortunately you might well relapse after a round of treatment). Taking the prokinetic before bed is best to help the overnight fast enable the MMC process. 
• To improve symptoms such as nausea, feelings of fullness and belching. You can take the prokinetic alongside your treatment for SIBO such as the antimicrobial herbal supplements. 

How long should you take a prokinetic agent for? 

Prokinetics can be taken for a few months at a time. Some people will take them for longer. You can test reducing your dose gradually, perhaps only taking it on alternate days as you feel better, or after around 3 months. Just notice if any symptoms return. Then you can slowly reduce your prokinetic to every 3-4 days, and so on. 

If you do feel symptoms are coming back you can revert back to your full dose to see if you can stop the SIBO returning. You could also add in some antimicrobial treatment at this time to knock the bacteria on the head and prevent another relapse of the SIBO. 

Are there any risks of taking prokinetics? 

You may experience some side effects such as 

• Diarrhoea  
• Bloating – this is because foods are being moved through the gut quicker, and if it’s not getting enough time to digest it could impair digestion causing bloating. 
• Pain – stimulation of smooth muscles in your digestive tract which might irritate your visceral hypersensitivity. 
• Acid reflux – particularly at the start of taking a prokinetic, if you’re very constipated you might feel 
• Ginger burn – you might feel better drinking more water with your ginger supplements to help wash it down.

Taking a prokinetic agent may not prevent your SIBO relapsing. However, it may extend the amount of time you have in between treatment rounds. This means there is more time for working on your lifestyle habits such as changing the way you eat and exercise, stress management, sleep routines etc.

As a SIBO Nutritionist I help people work out what to eat, how to eat and lifestyle changes to help get relief from symptoms. You can email me about setting up a discovery call, or use the form on my Contact page.