What is the gut if not really just a long muscle tube, housing your all-important microbiome and facilitating the digestion + absorption of food? Therefore the MOVEMENT of things through the gut is paramount to gut health. What happens if motility stalls in the small intestine + colon? SIBO, or small intestinal bacterial overgrowth. And if motility stalls in the stomach? Gastroparesis. A motility issue is likely at the root cause of most “IBS” diagnoses… This is just the beginning.
This is where prokinetics come in. The term prokinetic simply means to promote movement — and in the gut, promote gut motility + transit. What prokinetics are available?
Natural
1. Iberogast (STW5)
What is it? 9 different herbs, including milk thistle, chamomile, peppermint, and liquorice
Where does it work? Stomach
How does it work? Stimulated gastric relaxation and increased antral motility,
Treatment= 8 weeks of treatment with either STW 5 (3 × 20 drops/day)
2. Ginger
What is it? Ginger (Zingiber officinale) is a flowering plant whose rhizome, ginger root or ginger, is widely used as a spice and medicine.
Where does it work? Stomach
How does it work? Increases the frequency of antral contractions and accelerates gastric emptying.
Treatment= Following a fast of 8 h for solids and liquids, have a total of 1.2 g ginger root powder
3. Triphala (TLP)
What is it? Triphala is an ayurvedic herbal formulation of dried fruits from 3 herbal plants in equal proportions:
Terminalia chebula (black myrobalan)
Terminalia bellerica (bastard myrobalan)
Phyllantus emblica (emblic myrobalan or Indian gooseberry)
Where does it work? Small intestines
How does it work? The stimulatory action on the gut was supposedly mediated through the activation of muscarinic receptors.
Treatment= depends- talk to your doctor!
Pharmaceutical
1. Metoclopramide (REGLAN)
What is it? Dopamine blocker with central + peripheral effects, some serotonin activity
Where does it work? Stomach for gastroparesis
How does it work? improves gastric emptying by enhancing gastric antral contractions and decreasing postprandial fundus relaxation
Treatment= talk to your doctor! Up to 25% of patients may experience side effects, such as extrapyramidal reactions- some of these may not be reversible and led to the attachment of a “black box”
2. Domperidone
What is it? Dopamine antagonist (DA2) with only peripheral effects
Where does it work? Stomach for gastroparesis
How does it work? see above
Treatment= talk to your doctor! Not available in the US. Usually 10 mg three times daily and increase to 20 mg three times daily with an additional dose at bedtime.
3. Erythromycin
What is it? Motilin agonist
Where does it work? Stomach for gastroparesis
How does it work? Induces high-amplitude gastric propulsive contractions that increase gastric emptying.
Treatment= talk to your doctor! This is an antibiotic— so understand the implications of long-term antibiotic use!
4. Prucalopride (MOTEGRITY)
What is it? 5-HT4 agonist
Where does it work? Everywhere! accelerates transit through the stomach, small bowel, and colon… as well as on migratory contractions (MMCs)
How does it work? A systemic enterokinetic. A highly selective and potent serotonin‐4 receptor agonist which facilitates cholinergic and excitatory non‐adrenergic, non‐cholinergic neurotransmission. The drug is well absorbed and acts via a systemic mechanism to initiate peristalsis,enhancing the occurrence of giant migrating contractions and accelerating propulsion.
Treatment= talk to your doctor— anything from 0.5mg to 2mg daily at night on an empty stomach
NOT evidence-based prokinetics:
Low dose naltrexone (LDN): Naltrexone is an opioid antagonist that acts as a competitive antagonist at opioid receptor sites. Although theoretically using opioids is constipating so you could argue naltrexone would relieve constipation- but there is not enough evidence to use it for this reason. It is used effectively for people with alcohol and opioid dependence, and even pathological gambling disorders. Now there has been some evidence about naltrexone decreasing inflammation in inflammatory diseases such as Crohn’s disease and helping chronic pain especially in autoimmune disease.
Atrantil: Atrantil helps eliminate methane-producing bacteria. Active ingredients are M. balsamea wild (peppermint leaf) that is an antispasmoti to relax the small bowel, Quebracho with soass up hydrogen needed for methane production and disrupts the archaebacterial cell wall, and horse chestnut that inhibits the enzyme that allows methane to be produced
Herbal bitters (eg, gentian root, dandelion root and leaf, burdock root): there are theories about increased saliva/digestive secretions, increased blood circulation to abdominal organs and vagal stimulation to digestive organs… but no evidence that they indeed have prokinetic properties.
How your gut moves is INTEGRAL to your gut health.
Talk to me about optimizing motility with prokinetics.
Resource:
http://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm15094
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580135/
https://www.karger.com/Article/FullText/485410
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016669/
https://rd.springer.com/article/10.1007%2Fs10620-011-1653-7
https://journals.sagepub.com/doi/10.1258/ebm.2011.011121
https://atrantil.com/how-atrantil-works/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446506/
https://cmjournal.biomedcentral.com/articles/10.1186/s13020-018-0197-6