Treatment Strategies to Support Patients with Low Gut Motility
Joe Ornelas, PhD, DC
Many functional integrative medicine practitioners would agree that a fundamental principal of their practice is to pinpoint the root cause of dysfunction in order to truly help patients. Yet, this is not always easy to do, and some patients can be more frustrating than others. Such is true for patients with small intestinal bacterial overgrowth (SIBO), especially if numerous approaches to remove unwanted bacteria in the small intestine provide unsuccessful results.
SIBO is a common condition, where there is an overabundance of bacteria in the small intestine that is difficult to get rid of. But what is causing this overgrowth of bacteria in the first place? Impaired motility has been linked to SIBO and should be addressed as a root cause.1
Motility in the GI tract describes the movement of food and other substances from the stomach and small intestine into the large intestine and out of the body. Between meals, the migrating motor complex (MMC) is a specific three-phase cycle of motility that facilitates transport and “sweeps” indigestible substances and bacteria continually forward through the GI tract, inhibiting stasis or backward migration. In phase 3 of the MMC, brief and intense propagating contractions are responsible for most of the “sweeping” activity. Dysfunction or absence of phase 3 is associated with SIBO.1
There are several factors that can inhibit MMC activity, including stress, sluggish thyroid function, irregular eating patterns, and bacteria and immune imbalances in the gut. In fact, autoimmunity following infection by a pathogen producing cytolethal distending toxin B may be the leading cause of MMC impairment.2
In addition to eradication of SIBO,1 serotonin is shown to induce phase 3 of the MMC. So, serotonin (5-HT4) receptor agonists (e.g., metoclopramide, clebopride, mosapride) are commonly prescribed as prokinetics to reboot motility.
Recent studies are demonstrating that herbal-based motility agents work in a similar fashion. This is good news for the functional integrative medicine practitioner that wants a natural prokinetic approach for their patients.
Ginger and artichoke have a unique synergy to stimulate motility and relieve GI symptoms associated with SIBO.3 Motility can be stimulated by the molecular actions of ginger root’s lipophilic extracts, which modulate the integrated network of cholinergic M3 and serotonergic 5- HT3/5-HT4 receptors.3,4,5
With the complementary anti-spasmodic and choleretic actions of artichoke extract, full motility can be naturally restored3,5 to ensure steady movement of food particles and bacteria through the stomach and small intestine and into the colon, precisely what SIBO patients need.
The Bottom Line
The research behind prokinetic treatment approaches is advancing, giving the functional medicine practitioner a broader array of treatment strategies to assist in treating root cases of SIBO. Herbal-based prokinetics in the form of ginger and artichoke have efficacy as a prokinetic and may offer functional medicine practitioners a natural alternative to prescribed serotonin receptor agonists.
Pimentel M, Soffer EE, Chow EJ, Kong Y, Lin HC. Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth. Dig Dis Sci. 2002 Dec;47(12):2639-43. doi: 10.1023/a:1021039032413. PMID: 12498278.
Pimentel M, Morales W, Pokkunuri V, Brikos C, Kim SM, Kim SE, Triantafyllou K, Weitsman S, Marsh Z, Marsh E, Chua KS, Srinivasan S, Barlow GM, Chang C. Autoimmunity Links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes Following Campylobacter jejuni Infection in a Rat Model. Dig Dis Sci. 2015 May;60(5):1195-205. doi: 10.1007/s10620-014-3435-5. Epub 2014 Nov 26. PMID: 25424202.
Giacosa A, Guido D, Grassi M, Riva A, Morazzoni P, Bombardelli E, Perna S, Faliva MA, Rondanelli M. The Effect of Ginger (Zingiber officinalis) and Artichoke (Cynara cardunculus) Extract Supplementation on Functional Dyspepsia: A Randomised, Double-Blind, and Placebo-Controlled Clinical Trial. Evid Based Complement Alternat Med. 2015;2015:915087. doi: 10.1155/2015/915087. Epub 2015 Apr 14. PMID: 25954317; PMCID: PMC4411465.
Micklefield GH, Redeker Y, Meister V, Jung O, Greving I, May B. Effects of ginger on gastroduodenal motility. Int J Clin Pharmacol Ther. 1999 Jul;37(7):341-6. PMID: 10442508.
Lazzini S, Polinelli W, Riva A, Morazzoni P, Bombardelli E. The effect of ginger (Zingiber officinalis) and artichoke (Cynara cardunculus) extract supplementation on gastric motility: a pilot randomized study in healthy volunteers. Eur Rev Med Pharmacol Sci. 2016;20(1):146-9. PMID: 26813467.
Joe Ornelas, PhD, DC
Dr. Joseph Ornelas is the Pillars of GI Health Brand Manager at the Lifestyle Matrix Resource Center. He holds a PhD from University of Illinois with concentration in Health Economics, an MA degree in Public Policy from the Harris School at the University of Chicago, an MS degree in Health Systems Management from Rush University, and a DC degree from National University of Health Sciences. As a licensed chiropractor in the State of Illinois, Dr. Ornelas has published numerous evidence-based clinical practice guidelines, helping to improve quality standards of care and provide opportunity for health care practitioners across several specialty areas.