Today I'm going to talk about using prokinetics for SIBO and how to use them properly to prevent
SIBO relapse, so stay tuned. If you're a returning viewer,
welcome back. I'm really glad to see you again, and if you're new here, welcome for the first
time. My name is Amanda Malachesky. I'm a certified functional nutrition health, gut
health coach and a digestive and allergy detective. For weekly videos on how to find your
personalized plan for IBS and SIBO resolution, please consider subscribing and be sure to hit
the bell to be notified when I post a new video. What if I told you that there was a simple add-on
to your SIBO treatment plan that dramatically reduced the likelihood of relapse after SIBO
treatment? I'm talking about prokinetics, which are medications or supplements that encourage
the natural cleaning waves in your small intestine to prevent bacterial overgrowth.
As an expert in IBS and SIBO gut health, I can't tell you how many times I meet
people who are really struggling with repeated and recurring SIBO,
but haven't been told about prokinetics by their doctors or aren't aware of them. In this video,
I want to explain what prokinetics are and how to use them so you can put them to work for you
to help prevent SIBO relapse. Let's get started. All right. To start things off, let's first talk
about what prokinetics are. They're basically medications or supplements like I mentioned, that
help encourage material to move through your gut at a good speed so that bacterial overgrowth can't
build up. Now as I've mentioned in several other videos, SIBO is primarily a motility disorder,
meaning that the slowdown of movement of material through your small intestine is what leads to the
bacterial overgrowth called SIBO. Even if you remove the bacteria with antimicrobial herbs or
antibiotics, if you don't tend to this motility problem, the SIBO is likely to just regrow and
come back right after treatment or shortly after treatment. So prokinetics are medications that
help prevent that regrowth by just supporting that movement of material through your intestine.
There are several different types of prokinetic medications that have different mechanisms of
action. The first type are called cholinergic agonists, which sounds really complicated,
but it just means that the medication encourages the action of choline in
the gut. These types of prokinetics typically aren't used for IBS, they have other purposes.
The second type of prokinetics are called dopamine antagonists, meaning that they bind
to and block dopamine receptors. An example of this type of medication is called Reglan,
and Reglan is also not typically used for IBS or SIBO purposes. I do think that low-dose naltrexone
is an example of this type of medication, and in some circles, low-dose naltrexone has
been recommended as a prokinetic for use after SIBO treatment. But the effect of the low-dose
naltrexone is pretty small and minimal compared to some of the other medications available for
this. It tends to not be strong enough to produce the effect that we're looking for.
The third type of prokinetics are called serotonergic agonists. So again, an agonist
is something that promotes something else. This medication promotes the action of serotonin in
the gut. And we know that something like 70 to 80% of the serotonin in our bodies is produced in our
gut, and there are tons of serotonin receptors there. These serotonin receptors have something
to do with our gut motility. They are involved in that process. So one medication that used
to be used for this was called tegaserod, and I'm not sure if that's how you pronounce it.
It's no longer used for IBS purposes because it tended to show some side effects on the heart.
But there's another serotonin agonist that came out in the last couple of years called
prucalopride. And this medication seems to work generally really well
with fairly minimal side effects and has a very targeted action on the small intestine,
and so is a really useful prokinetic for use after SIBO treatment. Use of prucalopride usually helps
prevent SIBO relapse on average for six months. And the fourth category of prokinetic medications
are called macrolides, and these are usually antibiotics that have some sort of prokinetic
effect, and the most commonly used one for the purposes of post SIBO treatment is called low-dose
erythromycin. There are also some herbal options that can be used in
this context. One is called MotilPro, which is primarily a ginger supplement. And the
other is something called Iberogast liquid. It's a liquid herbal supplement that again,
encourages this small intestinal motility and cleaning. These herbal supplements tend to have
a less specific mechanism and effect than the medications, and they may need higher doses
to achieve the same level of prokinetic activity than the medications, but they are also options,
and for some people they're sufficient. Now, I do want to take a minute to note
that laxatives are not the same as prokinetics. Laxatives are more directly targeted to the colon
and usually have some impact on the amount of liquid or water that's hanging out in the
bowel and, or they're causing colonic spasms that help evacuate stool. These supplements
are medications will produce bowel movements, but they don't have the same direct effect on
the small intestine to move things through and encourage those natural cleaning waves in the
small intestine. This means that supplements like senna or medications like MiraLAX are
not really good substitutes for targeted prokinetic medications post SIBO treatment.
All right, so how do you use prokinetics for SIBO treatment success? Typically,
it's recommended that you begin them immediately after finishing your SIBO treatment, whether
that was with antibiotics like rifaximin and neomycin or herbal antimicrobials like allicin
and oregano oil or the elemental diet. They're typically prescribed to use at bedtime because
our longest fast during the 24 hour period is our overnight fast while we're sleeping. And this
is the time of day when our natural and normal small intestine cleaning waves are the strongest.
And so using the medication at night helps really enhance and encourage that natural cleaning wave
process during our long overnight fast. Sometimes it can take a little tinkering
with the medication dose to get just the right amount so that you have a good therapeutic effect,
and you don't also have unwanted side effects like diarrhea or loose stools the next day. You can
discuss with your doctor the appropriateness of titrating the medication and strategies for like,
"How much should I try at first and how can I work up to the minimum needed therapeutic dose?"
Now, a lot of people will wonder if they should still use prokinetics if they already trend
towards diarrhea, and the answer is usually yes. Again just like I mentioned with the laxatives,
the encouragement of these natural cleaning waves in the small intestine is really distinct and
different from the process that can cause diarrhea in the large intestine. However that being said,
sometimes prokinetics will aggravate loose stools and trigger diarrhea. This is something you have
to navigate with the help of your doctor. Another question a lot of people have is,
how long should I continue using the prokinetics once I've started them? You should definitely
consult with your doctor to get a clear answer for this for your unique situation. But usually what I
encourage people to do is to think about trialing the medication or supplement for about two months.
Then you can titrate your prokinetic down and see if you maintain your symptom relief. If not,
then you may need to go back to them and keep going for a while. If you're
maintaining symptoms, then congratulations, you've made it to the other side of SIBO.
But it is important to know that people who use prokinetics after SIBO treatment tend to have
longer periods of remission after their SIBO treatment than those who do not. On average,
it lasts more like six months versus one month. The name of the game is using this consistently
for a little while to just encourage that natural cleaning wave action. And there's some evidence
to suggest that supporting it can help rebuild natural function if that natural function has
broken down for one reason or another. So you just want to use it and give your body a chance
to heal and recover and then test and see if you're still having success with that or not,
and whether you need to keep going. Do you have a question about prokinetics
that I didn't answer here in this video? If so, leave me a comment down below this
video and I'll be happy to answer. Well, I hope this video is given you
an overview of how prokinetics can help reduce the amount of relapse episodes you're having with your
SIBO. And I want to let you know that if you're someone who's been unsure how to navigate your
SIBO treatment for success, this is exactly the kind of thing I help my clients with inside my
online program called The Calm Digestion Method. I want to let you know that if you've been unsure
about how to successfully navigate your SIBO treatment, or how recurring SIBO that won't go
away, that this is exactly what the signature strategy that I teach my clients helps with.
If you want to get your hands on that strategy and see if it might be able to help you,
I want to encourage you to download my Roadmap to Gut Recovery. You can
grab a free copy of that Roadmap by going to confluencenutrition.com/roadmap and I will leave a
link for that in the description below this video. All right, let me know if this video was helpful
for you by clicking like or leaving me a comment. You might want to check out this
video called Frequently Asked Questions about SIBO next on that. It includes some really
important details. So hope that helps you out, and I look forward to seeing you all next time.