How to Pick A Prokinetic for SIBO
Picking a prokinetic is one of the most underrated subjects in the world of SIBO, IMO and IBS. Practitioners seem to haphazardly pick whichever their personal favorite is instead of picking one that actually works for their client. I think of two things when I’m thinking about the right prokinetic for my clients. The first being “how many migrating motor complex receptors can I target?” The second being, “is my client likely to be sensitive to any of the byproducts of specific receptor stimulation?” And along the same line of questioning, “is my client taking any medications that would be contraindicated against a specific receptor stimulation?”
There are five main receptors you can activate yourself to stimulate the migrating motor complex:
Acetylcholine agonists
5HTP agonists
Dopamine antagonists
Vagus nerve via it’s nervous system regulating effects, release of neuropeptides and hormones can promote motility OR slow it down
Motilin Receptors
[photo from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353128/]
Let’s give you some examples of Prokinetic products and which receptors are stimulated.
Integrative Therapeutics Motility Activator: this prokinetic gently stimulates the serotonergic and cholinergic systems. The dosing is minimal though, and unlikely to make a difference unless the client or patient titrates up.
Motilpro: this prokinetic is moderately stronger than Motility Activator and stimulates the serotonergic and cholinergic systems.
The drug Erythromycin stimulates motilin receptors. It is a strong option, but can cause side-effects such as nausea or cramping.
Chinese licorice: this herb supports the mucous membranes and by promoting GABA can support the vagus nerve.
SIBO-MMC: this prokinetic contains jujube, which supports the vagus nerve. It contains 5HTP as well to stimulate 5HT receptors.
I measure our success with prokinetics in a few ways.
The first being to measure our success against fermentation levels on the Food Marble. Methane and Hydrogen levels should start to shift if we have chosen the right product/s at the right dose.
The second being to have clients measure their own transit time using a home-transit time test. This can be done using blue dye or sesame seeds.
Often I will provide clients samples of prokinetics and have them try different combinations. One alone is sometimes not enough, especially with the low doses in certain of these products. I might also custom compound my clients a prokinetic that contains multiple options for stimulating the MMC in multiple ways. Through compounding prokinetics we’ve been able to beat the prices AND dosing of most of the prokinetic options in Canada. These are viewable in our shop online.
